Cincinnati 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.

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

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 nearby 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 Cincinnati-area 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, Stan Chesley.

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

"That's as keen an issue here as what I'm paid," 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 the Cincinnati market.

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.

Bullard said that in the last several years, he has sent patients to Columbus or Cleveland for back operations or other surgeries because no specialists in the Cincinnati area were available.

Dr. James Pritchard, a Kenwood internist, said he and his partner, Dr. Ron Hsieh, rarely take vacations and each have only four days off a month because of sharing on-call duties.

They interviewed six young doctors over a year's time to try to get some help in their practice, but all the doctors turned them down, Pritchard said.

"We had a limit on what we could offer," he said, declining to say what the salary offer was. "For the last nine months, we haven't interviewed anybody. We just haven't bothered."

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

Lawsuits combined there in 2000 accuse the insurers -- including those being sued in Cincinnati -- 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.

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, Chesley said.