By John Nolan
The Associated Press

Internist Newton Bullard said he reached a breaking point when he was forced to call around to various hospitals to find a vascular surgeon on call to treat one of his patients.

Mr. Bullard said the city has suffered from an exodus of specialists caused by years of reduced reimbursements to doctors from health care insurers.

Mr. Bullard and other Cincinnati-area doctors have filed a lawsuit accusing the insurers of illegally using their market power to pay doctors less than the cost of providing treatment and less than that received by doctors in comparable cities. Lawyers representing the doctors allege the short-changing has been going on since at least 1995.

Humana, Aetna, United Healthcare and Anthem Blue Cross and Blue Shield, which are named as defendants, say they offer competitive reimbursement rates and have not done anything wrong.

The lawsuit - and a companion lawsuit in Northern Kentucky - blames the four health care insurers for undermining health care. The doctors say it has become difficult for medical practices to recruit young doctors who can make more money in similar-sized cities elsewhere.

The doctors say they want reimbursement rates similar to that received by physicians in comparable regional markets such as Dayton, Louisville, Columbus and Indianapolis. An Indianapolis physician is reimbursed at 70 percent of every dollar billed, while a Cincinnati doctor receives 35 percent to 50 percent, said their attorney, Stanley Chesley.

The lawsuit contends older specialists retire sooner, rather than accept less reimbursement for their services, and patients are waiting weeks or months to get appointments with specialists.

"That's as keen an issue here as what I'm paid," Mr. Bullard said. "It will only get worse unless there's a rapid reversal in this situation."

The insurers say they are not responsible for doctors deciding to locate outside the city or retire early.

"It doesn't have anything to do with how many doctors are here or when they came to the community or how many neurologists are still here," said James Adams, a lawyer for Anthem who asked a judge to throw out the doctors' lawsuit.

The Cincinnati Academy of Medicine and doctors who signed onto the lawsuit filed in June say the problem developed after the city's major employers - Procter & Gamble, Cincinnati Bell, General Electric and Kroger Co. - backed a study in the early 1990s of the quality and costs of health care in Cincinnati.

The employers told health insurance companies they wanted to hold down costs of health care, and that prompted the insurers to illegally reduce reimbursements to physicians, the doctors allege.

Spokesmen for Cincinnati's major employers said the study was intended to improve the quality of health care, not create the conditions the doctors cite.

"It was never a study that targeted health care reimbursement rates," said spokesman Rick Kennedy of GE Aircraft Engines in Evendale.

P&G got involved in the study because the company wants to ensure health care quality so that its employees would want to live and work in the city, spokeswoman Linda Ulrey said.

Health care insurers are also under attack in a Miami federal court.

Lawsuits combined there in 2000 accuse the insurers - including those being sued here - of deceptive trade practices and failing to give patients choice in health care providers.

A federal judge has approved the Miami litigation as representing 700,000 physicians nationwide.

Lawyers for the insurers are trying to persuade judges to dismiss the lawsuits and order arbitration, which the insurers say their contracts require for resolving disputes.

Doctors say they are already under pressure because of increases in their costs for malpractice insurance and for health care coverage for their own employees.

Archie Lamb, a lawyer representing doctors in the Miami lawsuit, said a concentration of power in an urban health insurance market by either a few major employers or a few insurers has created similar problems in Denver and San Francisco.

Humana, Aetna, United Healthcare and Anthem Blue Cross and Blue Shield together control 92 percent of the Cincinnati-area health care market and they pay similar reimbursement rates to physicians, Mr. Chesley said.

Harry Fry, 60, was a Cincinnati cardiologist for 25 years before he retired last year. Mr. Fry said reduced reimbursement for his services was a major factor in his decision to quit.

He said that in 1990, for every $100 in services he billed for, he was reimbursed $92. In 2000, the year he decided to retire, his reimbursement per $100 billed was $29.

"To stay even, I had to work three times as hard," Mr. Fry said. "And no businessman would be willing to put up with that."