Aetna's Rx for High Doctor Fees: Lawsuits

In 2007 cardiologist Benyamin Hannallah charged $220 to evaluate patients admitted to the hospital where he worked, Jersey City Medical Center, across the river from New York. Then he opened his own practice and raised his fee for the 25-minute bedside consultation to $56,980, according to a lawsuit filed by Aetna (AET). The health insurer is suing Hannallah and five other New Jersey doctors for charging what Aetna calls "unconscionable" fees to treat patients admitted at four New Jersey hospitals.

The lawsuits could help determine what pricing limits insurers can impose on out-of-network physicians who don't have contracts with health plans that set how much a service or procedure can cost. "It's the uninvited guest who comes into your hospital room and then bills you and your health plan for outrageous, undisclosed amounts," says J. Edward Neugebauer, Aetna's chief of litigation.