A lawsuit filed on Tuesday by the Los Angeles County Medical Association (LACMA), California Medical Association (CMA) and a coalition of health care organizations and providers accuses Aetna Health of California of “routinely and illegally” denying patients access to out-of-network doctors.
The lawsuit was filed in Los Angeles County Superior Court. It alleges Aetna of threatening patients with denial of promised coverage if their members see doctors outside the Aetna network of providers, and threatening doctors with having their Aetna contracts terminated if those doctors refer patients outside the network.
“Aetna is putting profits ahead of patient’s health and safety; that’s immoral and too often it is also illegal,” Rocky Delgadillo, CEO of the nonprofit Los Angeles County Medical Association and the former Los Angeles City Attorney, said in a statement. “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.”
Joining as plaintiffs are the Santa Clara County Medical Association (SCCMA) and Ventura County Medical Association (VCMA), along with more than 60 physicians, four surgery centers, as well as a California man who was denied reimbursement for much-needed surgery by his doctor.
The allegations against Aetna include false advertising, breach of contract, unfair business practices, and interference with healthcare providers. The suit seeks an an immediate injunction, compensation for patients and physicians, and punitive damages.
Aetna Health of California is a division of Aetna Health Management, based in Hartford, Conn.