Thousands of doctors in California claim the insurer is interfering with patient care.
A health insurance lawsuit filed by doctors in the California Medical Association (CMA), Los Angeles County Medical Association (LACMA), and a healthcare organizations and provider coalition is claiming that Aetna is routinely and illegally denying its policyholders access to doctors when their policies state that they are permitted to select their own providers.
The suit was filed against the insurer with the Los Angeles County Superior Court.
It alleges that Aetna’s practice is threatening patients who have been denied coverage, despite the fact that they have been promised the right to access to doctors outside the insurer’s provider network. It also states that doctors are being threatened by the insurer in the form of potentially lost contracts with the company if they should give patients referrals to doctors outside the network.
The lawsuit claims that these health insurance threats have been carried out several times.
According to former Los Angeles City Attorney Rocky Delgadillo, the CEO of the Los Angeles County Medical Association, a nonprofit organization, “Aetna is putting profits ahead of patient’s health and safety; that’s immoral and too often it is also illegal.”
Delgadillo went on to say that “The insurance company interferes not only with doctor-patient relationships, but also harms the ability of California health care providers to get sick people the care they need in a professional and timely manner.”
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The Ventura County Medical Association (VCMA) and the Santa Clara County Medical Association (SCCMA) will also be joining the CMA and the LACMA, along with four surgery centers, over sixty physicians, and a resident of California whose surgery health insurance reimbursement was denied.
The CMA’s general counsel and vice president, Francisco J. Silva, stated that the purpose of the suit is to provide patients with some defense for their right to quality care, which is currently being ignored by Aetna. Silva called this an example of the way that increasing profits and cutting costs are taking priority over the relationship between a patient and his or her physician.
Among the allegations against the health insurance company are breach of contract, false advertising, unfair business practices, and interference with healthcare providers that is both intentional and negligent.