Cuomo Warns Major Health Insurers About Promoting Potentially Deceptive Physician Ranking Programs

NEW YORK, NY (August 16, 2007) - Attorney General Andrew M. Cuomo today warned two major health insurers, Aetna and Cigna Healthcare, that their physician ranking programs, as currently designed, are likely to confuse or even deceive consumers. In letters to the two insurers, Attorney General Cuomo expressed concern about the design of the programs and requested a full justification for them.

"Transparency and accurate information are essential when consumers make healthcare decisions," said Attorney General Cuomo. "We will ensure that insurance companies are not obscuring important facts at the consumers' expense."

Aetna and Cigna Healthcare have significant enrollments in counties across New York State, including:

Aetna
Brooklyn: 40,278
Suffolk: 38,146
Westchester: 33,939
Rockland: 19,402
Onondaga: 1,311

Cigna
Manhattan: 5,200
Queens: 4,083
Brooklyn: 3,578
Suffolk: 3,988
Westchester: 3,209

UnitedHealthcare
Brooklyn: 35,449
Suffolk: 34,813
Onondaga: 18,811
Oneida: 9,882
Cayuga: 1,641

(Based on the 2005 New York State Managed Care Enrollment Trend Report)

For a complete list of county-based enrollment data, visit:
http://www.health.ny.gov

Health insurance companies create physician ranking programs to recommend certain primary care physicians and specialists to consumers. In his letter to Aetna and Cigna Healthcare, the Attorney General describes the problematic design of the physician ranking programs created by Aetna and Cigna Healthcare: the rankings are based on claims data, which is well-known to carry several significant risks of error when used to rank individual physicians; the insurers do not disclose the accuracy rate of their rankings; and insurers have a profit motive to recommend doctors who cost less, not necessarily those who are most qualified.

The letters also describe how inaccurate physician ranking programs may cause financial harm to consumers. Some employers steer employees to the doctors preferred by the insurer by lowering copayments or deductibles. Consequently, employees who choose not go to the preferred doctors could pay more.

Attorney General Cuomo has been closely observing the national trend of physician ranking programs with an eye toward protecting consumers. Today's letters follow Attorney General Cuomo's instruction to UnitedHealthcare, on July 13, 2007, not to introduce its physician ranking program in New York State without his prior approval. The Attorney General and UnitedHealthcare are currently involved in discussions about that program, which was scheduled to be introduced in October 2007.

Copies of the letters sent by Attorney General Cuomo are available at www.ag.ny.gov.

 

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