Intended for healthcare professionals


American Medical Association sues biggest US health plan over claims of underpayment of doctors

BMJ 2009; 338 doi: (Published 06 April 2009) Cite this as: BMJ 2009;338:b1427
  1. Janice Hopkins Tanne
  1. 1New York

    The American Medical Association and several state medical societies have filed a class action lawsuit against WellPoint, the largest health insurer in the United States.

    The lawsuit, filed in Los Angeles Federal Court, claims that WellPoint colluded with others to underpay doctors who were consulted by patients insured by WellPoint but who were not part of the company’s network. Such doctors are termed “out of network doctors.”

    The lawsuit says that because the reimbursable rates for these doctors were set too low, and because patients have to pay the balance of any medical fees presented to them by doctors, patients ended up paying an excessive part of their medical bills when they used out of network doctors.

    Doctors were …

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