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Nine California Surgery Centers, 60 Physicians Sue Aetna, Alleging Attack on Out-of-Network ASCs

A group of California physicians and medical groups has accused insurance company Aetna of reneging on medical benefits, escalating a dispute over payments for care in facilities that are out-of-network with the insurance provider, according to a 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.  

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