The suit argues that even though UnitedHealth and Oxford are operated as separate businesses, physicians are required to join both networks.
Plaintiffs argue that this has a negative impact on both patients and doctors because some patients have had to find new doctors who are members of both health networks. In some cases, this may have interrupted long-term care. Plaintiffs also claim that United is putting pressure on Oxford providers to accept plans offered by United, even if those physicians do not want to.This rule is known as an "all-products" requirement. Essentially, it forces doctors to do business with insurance companies they may not want to do business with. There are many reasons for preferring not to work with an insurance company including low payments, large amounts of paperwork and a lack of covered services. However, in this case if doctors do not agree to sign with both Oxford and United they risk losing their patients. Plaintiffs argue that this violates state antitrust laws and laws against unfair and deceptive trade practices.
Oxford's and United's rules also have an impact on patients. Patients who are on long-term care may be forced to switch doctors if their physician refuses to sign with both Oxford and United. This can cause interruptions to health care and delays in treatments.
This is not the first time physicians have complained about Oxford and United. Previously, complaints were made about reimbursement rates that weren't high enough to cover the cost of business. Hospitals, doctors, and patients have all complained that Oxford and United subject them to more unfair practices than other insurers.
Plaintiffs in the case include the Medical Society of the State of New York and eleven individual doctors practicing in New York City and on Long Island. The Medical Society is the statewide trade group for doctors in New York. The suit was filed in New York State Supreme Court in Manhattan.
Oxford Health Plans is one of the largest insurers in New York. In 2004, it was bought by UnitedHealth Group. In 2005, physicians in New York were told that if they wanted to stay in either of the insurers' networks, they had to be in both.