60 doctors sue Aetna Insurance for 'routinely denying' patients medical coverage

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About 60 California doctors are suing Aetna Insurance Company over alleged denials of medical coverage. The doctors have joined the California and Los Angeles County medical associations in a class-action lawsuit against Aetna Health of California.

The lawsuit filed in Los Angeles County Superior Court alleges that Aetna routinely threatens patients with denial of coverage if they see doctors out of network — although the plan they purchased allows them to do so. The suit also contends that the insurance company threatens member doctors with contract termination if they refer patients outside its network of providers.

"We’re appalled by this," said Dr. Samuel Fink, president of the Los Angeles County Medical Association. "We think when patients buy an insurance policy that the insurance company Aetna needs to adhere to the terms of that policy, and we want doctors to make health care decisions for their patients."

Aetna responded with an emailed statement that characterizes the suit as retribution after the insurance giant recently sued several Bay Area surgical centers for egregious billing practices.

We have sued some of these same doctors and surgery centers named in this suit for their egregious billing practices in February of this year. This is a countersuit disguised as a class-action lawsuit.

This is clearly retaliation against Aetna for our actions to prosecute physicians who are not looking out for our members.

The statement goes on to say that Aetna’s actions protect its customers against a small number of doctors who emphasize profits above patient care.

We will continue to pursue medical providers whose charges are so grossly out of line. For example, we are suing facilities and doctors who have charged:

  • $73,536 for a kidney stone fragmentation when an average in-network charge would approximately be $7,612.
  • $37,572 for a knee arthroscopy/ligament repair when an average in-network charge would approximately be $10,500.
  • $15,276 for bunion surgery when an average in-network charge would approximately be $7,943.

These egregious business practices, if not stopped, will continue to drive up the cost of care and health insurance for everyone.

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