The Los Angeles County Medical Association (LACMA), California Medical Association (CMA) and a coalition of health care organizations and providers filed a lawsuit against Aetna Health of California last week.
The lawsuit, filed in Los Angeles County Superior Court, alleges a systematic practice by 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. The insurance company has carried out both these threats in many cases, according to the suit.
Joining LACMA and CMA 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, and a California man who was denied reimbursement for much-needed surgery by his doctor.
Recommended For You
The allegations against Aetna include false advertising, breach of contract, unfair business practices, and both intentional and negligent interference with healthcare providers. The suit seeks an end to the practices, an immediate injunction, compensation for patients and physicians, and punitive damages including triple damages under the federal Lanham Act.
Along with this lawsuit, the coalition is issuing a call to action to the many patients, employers and physicians who have been denied coverage, threatened or retaliated against by Aetna. The coalition has established a page on LACMA's Website, LACMAnet.org, for patients, physicians and employers to share their experiences about Aetna.
LACMA and the other plaintiffs are being represented by the law firms, Liner Grode Stein Yankelevitz Sunshine Regenstreif & Taylor LLP, and Hooper, Lundy & Bookman, P.C.
The suit recounts the experience of a California man who purchased a Preferred Provider Organization (PPO) plan from Aetna in 2007. The advertised plan offered coverage at both in-network and out-of-network facilities, options the plaintiff wanted so his family could receive the best medical care possible.
The Aetna member's policy included coverage for out-of-network care and that the services provided were medically necessary, Aetna refused to pay for the surgery he finally received at an out-of-network facility. He filed three appeals and the insurance company eventually paid $9,000 of $70,000 in bills.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
