Aetna Sued by California Doctors Alleging Retaliation

Aetna Inc. (AET)’s California health insurer was sued by a group of doctors, surgery centers and an unidentified patient who said the company retaliates against patients who use out-of-network providers.

“Aetna retaliates against patients by making threatening telephone calls and sending threatening letters if they attempt to use their out-of-network benefits, by not authorizing care at out-of-network providers, and by grossly underpaying those out- of-network providers,” the groups said in a complaint filed today in California state court in Los Angeles.

The insurer also has terminated the contracts of doctors who refer patients with out-of-network benefits to out-of- network providers, according to the complaint. The plaintiffs, including the Los Angeles County Medical Association, accuse Aetna of unfair business practices and false advertising, among other claims, and ask for unspecified damages.

“We have sued some of these same doctors and surgery centers named in this suit for their egregious billing practices,” Cynthia Michener, a spokeswoman for Hartford, Connecticut-based Aetna, said in an e-mailed statement. “This is a countersuit disguised as a class-action lawsuit.”

Aetna sued Bay Area Surgical Management and seven ancillary facilities and their principals in February, claiming physicians sent Aetna members to facilities without telling them they had an ownership interest and were getting paid by the facilities for their referrals, according to the insurer’s statement.

The case is Los Angeles County Medical Association v. Aetna Health of California, BC487670, Los Angeles County Superior Court.

To contact the reporter on this story: Edvard Pettersson in Los Angeles at epettersson@bloomberg.net.

To contact the editor responsible for this story: Michael Hytha at mhytha@bloomberg.net.

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