AETNA OUT-OF-NETWORK BENEFITS: Los Angeles County Medical Association (LACMA), California Medical Association (CMA) et. al. v. Aetna (Los Angeles Superior Court, Case No. BC487412)
On July 3, 2012, LACMA, CMA, Santa Clara County Medical Association, Ventura County Medical Association, along with a coalition of health care organizations and providers filed a lawsuit against Aetna to protect the rights of patients and doctors to quality healthcare and to prevent insurers from interfering with patient choice. The lawsuit alleges a systematic practice by Aetna of threatening patients with denial of promised coverage if they seek medical care at an outpatient facility outside the Aetna network of providers, and threatening doctors with having their Aetna contracts terminated if those doctors refer patients out-of-network.
According to the complaint, Aetna has carried out both these threats in many cases. CMA and its co-plaintiffs are seeking injunctive relief to end Aetna's unlawful practices. After unsuccessfully trying to remove the case to federal court, Aetna filed multiple motions to dismiss the claims in Los Angeles Superior Court. The court rejected Aetna's first motion in December 2013, although it did request the plaintiffs to reallege some of their claims. Accordingly, CMA and its co-plaintiffs filed an amended complaint in January 2014. Aetna filed a motion to dismiss the claims in this latest complaint, but the motion was denied. The case is pending in state court, where the parties have begun engaging in settlement discussions. Progress has been made, so the parties are continuing to dialogue to reach a resolution of the lawsuit.