Do insurers really owe doctors a fiduciary duty?
Do insurers cheat doctors out of what they’re owed? At least 12 jurors in Kansas City think so. Thanks to them, six Missouri doctors dedicated to serving the poor won a stunning legal victory over a large insurer they’d accused of violating their trust and hiding financial data. Besides heartening other physicians weary of insurance wars, the case provides valuable lessons about the importance of reading and understanding contracts before signing them. The doctors, all pediatricians, had signed on with a nonprofit Medicaid HMO launched in late 1983 operated by Blue Cross and Blue Shield of Kansas City. They thought the contract promised a higher capitation rate if the program made money. Over the program’s 13-year history, though, capitation lagged behind medical inflation, according to insurance company records. When doctors sought answers from KC Blues executives in 1991, they were told no money was available for the kind of raises they expected, at least not yet. “Don’t worry, we’ll
