Tags: doctors | aetna | sue | coverage

California Doctors Sue Aetna for Coverage Denials

Thousands of doctors in California are suing the health insurance company Aetna Inc claiming the company routinely denies patients access to out-of-network doctors even when the patient has purchased a policy giving them the right to choose providers.

The lawsuit, filed in the Los Angeles County Superior Court, accuses Aetna of threatening patients with denial of coverage if their members visit doctors outside the Aetna network of providers, and of threatening doctors with having their Aetna contracts terminated if they refer patients outside the network.

The lawsuit was brought by the Los Angeles County Medical Association, California Medical Association and a coalition of health care organizations and providers.

It follows a lawsuit filed earlier this year by Aetna against several California facilities, including Bay Area Surgical Management (BASM)and seven ancillary facilities, claiming their physicians sent Aetna members to BASM without revealing that they had an ownership interest in the facility or were getting paid by BASM for their 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," Cynthia Michener, a spokeswoman for Aetna, said in an email. "This is a countersuit disguised as a class action lawsuit."

© 2015 Thomson/Reuters. All rights reserved.

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