California Medical Association, Aetna in Deep Billings Dispute

Tags: Aenta | California Medical Association | lawsuit | negotiation | network | payor contract

The California Medical Association physician's group has accused commercial payor Aetna of refusing to negotiate with member physicians or kicking physicians out of network as retaliation for a pending lawsuit, according to the Los Angeles Times.

The medical association said Aetna may be limiting patient access to physicians. Aetna responded and disagreed, saying it is fighting on behalf of patients against "egregious and improper billing practices" of physicians which are driving consumer costs.

The California Medical Association is the largest physician group in the state with 35,000 members. Aetna, the nation's third-largest health insurer, said it is limited in ability and willingness to negotiate with physicians with whom it has active litigation.

In February, Aetna filed suit again Bay Area Surgical Management and affiliated physicians, accusing them of overcharging the insurer $20 million in the last two year. The California Medical Association joined with the Bay Area Surgical in a suit again Aetna last month, alleging Aenta threatens physicians and patients who want to use out-of-network providers.

Both groups have denied claims.

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