Legal News

Doctors v Aetna, What’s Happening in California?
Download PDF
1 Star2 Stars3 Stars4 Stars5 Stars (No Ratings Yet)
Loading...

Apparently, thousands of doctors in California are suing the health insurance company Aetna Inc claiming that the company regularly attempts to deny patients any access to out-of-network doctors even if the patient purchases a policy that permits them to choose their own health providers. The lawsuit has been filed in the Los Angeles County Superior Court and accuses that Aetna threatened patients with denial of coverage if they visit doctors who are not part of Aetna’s network of healthcare providers. The lawsuit also alleged that the company threatens doctors within its network of terminating their contracts if they refer patients to doctors outside the Aetna network.

Healthcare seems to be simmering. Mandatory insurance, and now mandatory network.

The lawsuit, brought the Los Angeles County Medical Association, the California Medical Association and a coalition of health care organizations and providers accuse Aetna of false advertising, breach of contract, unfair business practices, and both negligent and intentional interference in the work of healthcare providers. The lawsuit seeks an immediate injunction to stop such practices and provide compensation for patients and physicians with punitive damages.

  
What
Where


The lawsuit stated, “Despite making tens of millions of dollars selling policies with out-of-network benefits, Aetna has engaged in a campaign to retaliate against its members who attempt to use their out-of-network benefits, and the physicians who refer these members to out-of-network providers.”

On their part, Aetna maintains that the lawsuit is in retaliation of steps taken by the company against some healthcare providers who charged exorbitant rates. Cynthia Michener, a spokeswoman for Aetna said, “We have sued some of these same doctors and surgery centers named in the suit for their egregious billing practices in February of this year … This is a countersuit disguised as a class action lawsuit.”

Cynthia Michener, further cited examples in support of the actions of Aetna, which if proved true, is quite revealing. For example, she cited doctors who charged $73,536 for a kidney stone fragmentation when Aetna’s average within network charge was around $7612. She further cited examples where a knee procedure which costs about $10,500 within the Aetna network was charged $37,572 by an out of network physician.

Get JD Journal in Your Mail

Subscribe to our FREE daily news alerts and get the latest updates on the most happening events in the legal, business, and celebrity world. You also get your daily dose of humor and entertainment!!




The lawsuit filed by Aetna in February claims that several California providers, including Bay Area Surgical Management and seven ancillary facilities sent Aetna members to BASM without disclosing that the physicians had ownership interest in the facility, or that they were getting paid by BASM for the referrals.





 

RELEVANT JOBS

Associate Attorney

USA-CO-Denver

DTC based firm is looking to add an additional associate to join our growing practice. The associate...

Apply now

Associate Attorney

USA-KS-Newton

Gillmore & Wilson: Attorneys at Law Job-type: Full-time Title: Associate Attorney Gillmore ...

Apply now

Family law attorney Westlake Village

USA-CA-Westlake Village

ZFLG is a boutique family law firm serving LA and Ventura Counties. We want to hire an experien...

Apply now

Estate Administration / Probate Paralegal

USA-PA-Philadelphia

I am looking for a part-time paralegal or legal assistant who is experienced, adept and proficient w...

Apply now

BCG FEATURED JOB

Locations:

Keyword:



Search Now

Senior Wealth Management Group Associate Attorney

USA-CA-San Diego

San Diego office of our client seeks Senior Wealth Management Group Associate Attorney with 9 years ...

Apply Now

Bankruptcy Associate Attorney

USA-CA-Los Angeles

Los Angeles office of a BCG Attorney Search top ranked law firm seeks Bankruptcy Associate Attorney ...

Apply Now

Tax Attorney

USA-FL-Miami

Miami office of our client seeks Tax Attorney with 2 years of experience. The candidate should be li...

Apply Now

Most Popular

SEARCH IN ARCHIVE

To Top