A Utah surgeon who says he was dropped from Altius Health Plans because he publicly questioned its decision not to cover a particular varicose vein treatment has sued the insurance company.
In a lawsuit filed this week in Salt Lake City's 3rd District Court, Dr. Craig Wilkinson says the termination of his agreement came just one month after his attorney sent a letter to the Utah Department of Insurance expressing concern about Altius' lack of coverage for a specific procedure.
"It was clearly an attempt to muzzle anyone who might dare to second-guess the company's basis or motivation for restricting its members' access to potentially life-saving varicose vein treatment," court documents state.
In her Nov. 17 letter, attorney Janet Jenson wrote that Altius' policy of not routinely covering "endovenous radiofrequency ablation (ERA)" instead of the more invasive "vein stripping" procedure puts patients at risk of greater health problems.
Jenson asked state insurance regulators to investigate Altius "for interfering with the competent practice of medicine" and possible fraud for allowing those it insures to believe it covered the procedure in all cases rather than under specific circumstances.
Though written on his behalf, the letter did not mention Wilkinson by name. The lawsuit, however, maintains that an Altius official knew of his prior attorney-client relationship with Jenson and discovered him to be behind the correspondence.
Later that month, an attorney for Coventry Health Care, Altius' parent company, responded by letter to Jenson, disputing her allegations and noting that if her client was dissatisfied with the policy, "your client is free to terminate the participating provider agreement with Altius."
On Dec. 27, Wilkinson received notice that his medical services agreement with Altius would be terminated effective March 27. It did not give a reason for the termination.
Under the terms of the agreement, Altius is allowed to terminate its relationship with Wilkinson without cause at any time. Still, Jenson said, Altius' actions constitute a breach of contract.
"Our argument is that just because you have discretion doesn't mean you can exercise it in bad faith to punish them or silence them," she said, citing several Utah Supreme Court decisions she maintains supports her client's position.
"All contracts have in them an obligation to act in good faith, even if you have the discretion to terminate the contract," Jenson said. "But you can't do it for the wrong reasons. You can't punish, you can't retaliate, you can't use it as a weapon."
Wilkinson, a Salt Lake-based vascular surgeon, has contracted with Altius since December 2000.
"He is probably the most excellent vascular surgeon in Utah," she said. "There has been no question of his competence, no question of his medical skills."
Coventry Health Care attorney Rob Fox declined to comment on the case, nor would he say Tuesday why the agreement with Wilkinson was terminated.
On Tuesday, 3rd District Judge Glenn Iwasaki denied Wilkinson's request for a temporary restraining order, which would have allowed him to continue treating Altius patients until the lawsuit is resolved. The case will now move forward toward trial.
E-mail: awelling@desnews.com