Doctors Sue Aetna for Coverage Denials

submitted by: admin on 09/20/2013

Thousands of doctors, through the Los Angeles County Medical Association and the California Medical Association are suing Aetna Insurance Company for routinely denying patients access to out-of-network doctors even when the patient had purchased a polilcy giving them the right to choose their provider. They are accusing Aetna of threatening patients with denial of coverage if they don't use Aetna providers, and also threatening doctors with having their Aetna contracts terminated if they refer patients outside of the network.

This information makes one think that this law suit is a slam dunk for the doctors. However, keep in mind that there are two sides to this story. Earlier in the year, Aetna brought forth a law suit against doctors and surgery centers of charging outrageous fees for their services. Examples cited included a bill for $73,000 for a kidney stone fragmentation procedure when the average in network charge was only $7600, and a bill for $37,000 for a knee procedure that would have cost only $10,500 when done inhouse. 

Obviously, economics are being abused by both parties. Service should be the highest priority, not profit.

Doctors Sue Aetna for Coverage Denials (Video)

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