The lawsuits allege that because of the "extraordinary unequal bargaining positions" between the TMA and HMOs, the TMA's 6,600 members are forced into one-sided contracts that ultimately "impede good medicine." According to TMA President Dr. David K. Garriott, the association "regrets that we have been forced to go to court to improve the managed care environment that has become unmanageable for so many of our members and patients."

The lawsuits, which seek class action status, say these unfair business practices include:

• Arbitrarily denying claims for "medically necessary" care without adequate justification or explanation.

• Reducing a physician's payment for medically necessary care by "downcoding," meaning changing billing codes to indicate a doctor should be paid less. (For example, a doctor conducts an extensive office visit with a patient who has a number of health problems but is reimbursed only for a simple office visit that is far shorter and less complicated.)

• Bundling claims, meaning issuing a single payment for a group of related medical services, rather than paying for each service individually.

• Improperly reviewing claims by using computerized programs to automatically deny or reduce claims by downcoding.

• Failing to pay claims on time.

Tennessee joins the growing number of states with medical associations that have filed lawsuits to take HMOs to task for secretive business practices that the doctors claim are abusive and "allow insurers to avoid their obligation to pay for care provided to patients." Attorneys working with medical associations in Connecticut, South Carolina, and New York that have brought lawsuits against many of the same HMOs and leveled virtually identical charges.