Nine California Surgery Centers, 60 Physicians Sue Aetna, Alleging Attack on Out-of-Network ASCs
Bloomberg Businessweek report.
More than six dozen physicians, medical associations and surgery centers sued the insuer in California court on July 3. They alleged the company retaliated against physicians and patients for using surgery centers that do not have contracts with the company.
The plaintiffs asked a Los Angeles court to prevent Aetna from terminating physicians from contracts for referring patients to out-of-network facilities. The new lawsuit alleges that Aetna violates state fair business and false advertising laws by selling insurance policies with out-of-network benefits, and then intimidating physicians and benefits into referring to and using in-network facilities only.
"Aetna's practice of forcing doctors to preclude Aetna patients with out-of-network benefits from actually using those benefits constitutes a clinical gag clause," the plaintiffs alleged in the lawsuit.
The group suing Aetna includes 60 named physicians, nine surgery centers, the California Medical Association and the medical associations of Los Angeles, Santa Clara and Ventura counties.
Related Articles on Coding, Billing and Collections:
CMS Proposes 2013 Payment Rate for ASCs
10 Statistics on Payors Dropped by Physicians Since 2009
5 Qualities to Look for in a Surgery Center Third Party Patient Financing Program
© Copyright ASC COMMUNICATIONS 2012. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.
New from Becker's ASC Review