Thousands of California doctors have banded together against insurance giant Aetna. The doctors filed a suit against the company in the Los Angeles County Superior Court accusing them of denying patients coverage for out-of-network doctors visits.
The thousands of doctors involved in the suit claim Aetna even refused patients who purchased a policy that allowed them to visit any doctors, whether they were in the network or not.
Reuters reports that the suit was brought by Los Angeles County Medical Association, the California Medical Association, and a variety of health care organizations. The complaint totals 29 pages and was filed on Tuesday, Modern Healthcare reports.
Countering the doctors’ claims, spokespeople for Aetna claim that the new lawsuit is a retaliation to a lawsuit the insurance giant filed against Bay Area Surgical Management in February. In that lawsuit, Aetna charged that most of the doctors overcharged for procedures, in some cases the insurance company claims they overcharged 10 times what they should have for some procedures.
Additionally, Aetna claims that doctores referred patients to out-of-network facilities that were owned by those same medical professionals, thereby gaining a profit without telling their patients.
Reuters quotes an Aetna spokesperson, Cynthia Michener:
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.
Michener made it clear that Aetna will continue to go after doctors who have accused the company with charges that are “grossly out of line.” MSNBC quotes Michener as saying, “This is a countersuit disguised as a class action suit.” The lawsuit filed by the doctors represents an important stand against the dominance of insurance companies in the medical field. The suit demands compensation for patients and medical professionals in the face of unfair business practices and false advertising.
Actively threatened patients
The newest complaint also asserts that Aetna actively threatened patients with denial of coverage and ejection from the program if they attempted to visit an out-of-network facility.
As Modern Healthcare sums up, the “plaintiffs also seek an order from a judge directing Aetna to cease and desist from discouraging the use of out-of-network providers, and declaring that any Aetna contracts with providers that restrict referrals for out-of-network care are illegal and not enforceable.”
A pitched battle between healthcare providers and insurance giants illustrates the often strained relations between branches of the health care system in the United States. The personal and business interests of companies, both in insurance to pharmaceuticals, continue to plague individuals who have purchased health care but do not receive the coverage they paid for. In this regard the suit these doctors have presented against Aetna has some ground, if they can find and defend the evidence to back up their claims.
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