Lovelace Sues ABQ Health Partners [Albuquerque Journal, N.M.]

Oct. 22--Lovelace Health Plan has asked the state District Court in Albuquerque to stop a medical group from trying to get its patients to switch insurance companies.

Lovelace accuses the 184-physician ABQ Health Partners of breaching its agreement with the health plan by soliciting Lovelace customers to change insurers, of interfering with Lovelace's business relationships with its members, and of violating state and federal regulations governing marketing to customers of Lovelace's Medicare Advantage plan.

The suit, filed Friday and provided to the Journal on Sunday, claimed that "ABQ HP is engaged in a smear campaign against Lovelace in an effort to mislead and confuse Lovelace's members" in order to get members "to sever their relationship with Lovelace in favor of a health plan that ABQ HP now accepts."

Lovelace charged that the practice "disseminated demonstrably false and illegal information" about the company. The suit says Lovelace's contract with the physicians prevents them from disparaging Lovelace or soliciting Lovelace customers.

ABQ Health Partners said in a statement released Sunday that it is Lovelace that is "giving out misinformation to our patients in what we think is an attempt to confuse or frighten them into switching doctors instead of allowing them to make their own health care choices."

"At ABQ Health Partners, we are trying to educate our patients about their basic rights," the statement said. "Lovelace Health Plan is trying to prevent this through a new lawsuit and through misleading advertisements and confusing communications."

"ABQ Health Partners strongly believe that our doctors and providers have every right to discuss changes in care directly with their patients," the statement said. "It is unfortunate that Lovelace has chosen to try to restrict information, communication and choice by making meritless claims in court and choosing to pay for lawyers instead of using that money to improve health care in New Mexico."

"We're merely seeking to stop dishonest, abusive, inappropriate practices by ABQ Health Partners," Lovelace Health System CEO Ron Stern said in an interview Sunday. Lovelace Health System owns Lovelace Health Plan.

"They are practices that are illegal and misleading, especially when those physicians have a financial interest in those health plans."

ABQ Health Partners has provided medical services to Lovelace plan members for the past five years. The practice terminated its contract effective Nov. 8, and efforts to reach a new agreement failed.

State insurance superintendent John Franchini said Friday that the companies had agreed to continue their agreement until year's end and would meet Wednesday to hammer out a written understanding. However, both Lovelace and ABQ Health Partners denied any such understanding exists.

Lovelace has tried to work to get new doctors for ABQ Health Partners patients, and ABQ Health Partners has told patients which insurance the practice accepts. The companies have sent letters to customers' homes, have staffed their facilities with customer service advisers and have advertised extensively.

-- Email the reporter at [email protected]. Call the reporter at 505-823-3896

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