Physical therapists sue Anthem Reduced payments cited

BANGOR – At least a hundred Maine physical therapists have joined forces in a class-action lawsuit against the state’s largest health insurance company, Anthem Blue Cross and Blue Shield of Maine, according to the plaintiffs’ attorney. The suit alleges that Anthem violated state antitrust laws by abruptly decreasing its payments to physical therapists, using its market-dominating status to pressure the providers into accepting the lower reimbursements.

A spokesman for the insurance company said Tuesday that the case is without merit.

Attorney Gregory Brodek of Bangor said Tuesday that the case stems from Anthem’s announcement in 2006 of a 25 percent to 35 percent reduction in the fees paid to physical therapists. The notification came after physical therapists already had agreed to reduce their charges in order to continue providing services to Anthem’s many policyholders, he said.

The case was filed last summer in Penobscot County Superior Court in Bangor and then referred to the newly established Maine Business and Consumer Court. It has recently been court-approved to move forward.

Since low-paying public programs like Medicare and Medicaid make up such a large percentage of Maine’s insurance providers, Brodek said, health care professionals have little choice when it comes to doing business with Anthem, which makes up the bulk of private insurance in Maine and has a virtual monopoly in the individual and small-group market. The company, which is headquartered in Indiana, writes 68 percent of small group policies and more than 85 percent of individual policies in Maine.

The company’s “unilateral” fee-reduction notice didn’t set well with physical therapists, Brodek said.

“Anthem basically said, ‘If you don’t like it, just let us know and we’ll terminate you from all our contracts,'” Brodek said. Being driven out of Anthem’s provider network would leave physical therapists with a depleted client base, he said, and also sharply limit patient access to physical therapy services.

“Anthem realizes it is the 8,000-pound gorilla,” Brodek said. “And in our view, this runs afoul of antitrust laws.” Brodek specializes in antitrust law and said he has 12 cases against insurers pending in other states.

Anthem spokesman Mark Ishkanian said Tuesday that”in 2006 Anthem changed its fee schedule for physical therapists. We believe that the changes were made in full compliance with the terms of our participating contracts and with the laws of the state of Maine. We believe the lawsuit is without merit and will vigorously defend ourselves against this suit.”

The suit seeks retroactive reimbursement of payments to physical therapists equal to the pre-2006 reduction, as well as damages and attorneys’ fees that could run into the millions of dollars, according to Brodek. More than 100 physical therapists are party to the suit.

Mila Kofman, superintendent of the Maine Bureau of Insurance, said Tuesday that her agency has no regulatory authority over insurers’ contractual arrangements with health care providers. But if the network of physical therapists were to be significantly reduced, she said, the state “would take a good, hard look at it.”