Docs claim Aetna booted them from network in retaliation for lawsuit


Aetna is abruptly ending contracts with many doctors in retaliation for them participating in a lawsuit against the insurer initiated by the California Medical Association (CMA), the Los Angeles Times reported.

The CMA, along with the Los Angeles County Medical Association and two doctor coalitions, sued the insurer in July, claiming Aetna threatened to deny patients' coverage for visiting out-of-network doctors and to terminate doctors' contracts if they refer patients outside the network, FierceHealthPayer previously reported.

Since filing that lawsuit, the CMA alleged Aetna has terminated its contracts with any physician members of the organization. Aetna "must stop these egregious and retaliatory actions against physicians," CMA President James Hay said Thursday in a statement. "Aetna is essentially saying that they will no longer do business with the 35,000 members of CMA."

For example, David Aizuss, an ophthalmologist in Los Angeles who is participating in the CMA lawsuit, said Aetna is ending his contract in November. "It's retribution for participating in that case," he told the LA Times. "They are impacting the doctor-patient relationship for thousands of people."

Aetna, however, refuted the CMA's claims, alleging it is terminating contracts because doctors are referring patients to out-of-network facilities that they partly own without notifying patients about the potential conflict of interest. It filed its own lawsuit against the Bay Area Surgical Management California for alleged illegal overbilling practices.

"Physicians and their business partners secure outsized and improper windfalls at the expense of Aetna's plan members and employer plan sponsors," Ed Neugebauer, an Aetna lawyer, wrote in a letter to the CMA.

To learn more:
- read the Los Angeles Times article
- see the CMA statement

Related Articles:
Hospital group sues Aetna for allegedly denying out-of-network access
Aetna sues surgery centers for overbilling
Aetna's $7.3B Coventry purchase boosts Medicare position
Who won the Twitter war of words--Aetna or patients?
Aetna-provider plan offers price guarantees to stay competitive
Fierce Q&A: New Aetna ACO leverages health IT
Aetna fined $1M for not covering services, false advertising