Hundreds 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.