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Aetna Out-of-Network Provider Class Action Lawsuit

By Mike Holter

 

AetnaHundreds of California doctors have filed a class action lawsuit against insurance provider Aetna, Inc., accusing the company of denying patients coverage they already paid for. According to the class action lawsuit, Aetna refuses to cover out-of-network doctors despite patients purchasing a policy giving them the right to choose providers, and retaliates against patients and doctors for using outpatient units outside Aetna’s network of preferred providers. The class action lawsuit is seeking compensation and unspecified damages for both patients and physicians.
 
The doctors allege in the Aetna class action lawsuit, filed in Los Angeles Superior Court, that Aetna threatened patients with denial of coverage if their members visited doctors outside the Aetna network of providers, and threatened doctors with having their Aetna contracts terminated if they referred patients outside the network. They are accusing Aetna of false advertising, breach of contract, unfair business practices, and both intentional and negligent interference with healthcare providers.
“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,” the Aetna class action lawsuit states.

An Aetna spokeswoman denied the charges, saying the doctors’ class action lawsuit is in retaliation for a lawsuit filed by Aetna in February claiming several California surgery centers, managed by Bay Area Surgical Management, LLC, referred Aetna members to facilities without revealing that the referring physicians had an ownership interest in the facility or were getting paid by the facility for their referrals. The Aetna lawsuit accuses the centers of gouging patients on rates and paying illegal kickbacks to owner-doctors for self-referrals.

“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,” the Aetna spokeswoman said in an email. “This is a countersuit disguised as a class action lawsuit.”

The doctors’ Aetna class action lawsuit is asking the court for an immediate injunction to end Aetna’s alleged unlawful practices, in addition to compensation for patients and physicians, and punitive damages.

The Aetna out-of-network provider class action lawsuit is brought by 60 named doctors, nine surgery centers and the Los Angeles County Medical Association, California Medical Association and a coalition of health care organizations and providers.

The case is Los Angeles County Medical Association, et al. v. Aetna Health of California, Inc., Case No. BC487670, Los Angeles County Superior Court.

 

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Updated July 13th, 2012

 

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4 Comments

  • Michael January 16, 2013

    AETNA is going down.. I am in the medical business and have to deal with them every week. They are the most corrupt insurance company out there. They NEVER pay claims on the first submission and ALWAYS make up bogus excuses not to pay.. they do this EVERY TIME hoping you will get frustrated and stop billing them for legitimate services you have provided. The unfortunate part is that other insurance companies are all doing the same thing. I have thousands of dollars in outstanding bill which I cannot get paid form these insurance companies because of there BOGUS excuses. Something needs to be done to correct this corruption.. they are out of control. Insurance companies are quick to take your money in premiums but NEVER pay out.. what a horrible scam..

    • jami February 6, 2014

      Hi there!
      They never paid claims on the any of my Medical Benefit request submission and always gave me excuses not to pay.How do I get involved? I was so frustrated and stop sending Medical Benefit request. These request are legitimate and should be covered. can you help??

  • Charlotte Brock March 1, 2014

    I was sent a claim form , from a law firm on a class action law suit that had to be filed by march 15 for out of pocket expenses , or out of network providers for Aetna but have misplaced my form , does anyone know who to contact to find out the information to file or be included I live in TEXAS , and worked for Boeing and the bought out by BAE Systems , any help would be greatly appreciated .

  • K March 21, 2014

    Aetna practices are not what they should be.

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