Aetna Sued By Thousands Of California Doctors For Coverage Denials

Aetna is being sued by thousands of doctors in California who claim the health insurance company has routinely denied patients access to out-of-network doctors, even when the patient’s policy gives them the right to choose their health care provider.

The lawsuit is being filed in the Los Angeles County Superior Court by the Los Angeles County Medical Association, California Medical Association and other health care providers. The lawsuit claims that Aetna threatens to deny patients coverage if they choose a doctor outside of the network, and that the company has also threatened to terminate doctors’ Aetna contracts if they refer patients to doctors outside of the network.

The former Los Angeles City Attorney and CEO of the Los Angeles County Medical Association, Rocky Delgadillo, said, “Aetna has given us no choice. Aetna’s assault on patient rights and its abandonment of its promises — its contractual responsibility to patients, doctors and employers — has to be stopped.”

The physicians bringing the lawsuit against the health insurance company are accusing Aetna of false advertising, unfair business practices, breach of contract and intentional and negligent interference with healthcare providers.

Aetna claims that the suit is in retaliation for a lawsuit the company filed in February. Aetna’s lawsuit alleged that healthcare providers were sending their members to Bay Area Surgical Management without revealing that BASM’s physicians were getting paid for their referrals and had an ownership interest in the facility.

Aetna spokeswoman Cynthia Michener said in an email, “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.”