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GEN - HMO on the defensiveFrom: art fougner, md (evsono@pipeline.com)Wed Jul 19 11:38:18 2000
this on today's Reuters Brown & Toland sues Aetna for breach of contract WESTPORT, Jul 19 (Reuters Health) - The largest independent network of physicians in San Francisco is suing Aetna US Healthcare for breach of contract, alleging that Aetna's conduct has resulted in millions of dollars in damages Brown & Toland Medical Group said on Monday that it filed suit against the managed care giant in San Francisco Superior Court in June. The independent practice association (IPA) of 1,600 physicians said that it began receiving inaccurate eligibility and payment information in July 1997, after the Aetna acquisition of US Healthcare. The merged company used data systems that were incompatible with the Brown & Toland's information systems and Aetna failed to provide a functional and practical way to update, use, and reconcile eligibility and financial data, the medical group alleges. As a result, Brown & Toland says that it could not determine who was enrolled in the plan, pay its participating physicians correctly, or get timely and accurate payment from Aetna. The IPA also contends that the insurer intentionally delayed assigning certain enrollees a primary care physician until they needed care. -Westport Newsroom 203 319 2700 Art
-- art fougner, md
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