Doctor groups sue Aetna, insurer says it's retaliation

In their lawsuit, California physicians claim Aetna is unfair to patients getting care outside of preferred-provider networks. The company says the suit is payback for Aetna's own suit alleging corruption earlier this year.

The Wall Street Journal: Aetna, Doctors Face Off Over Costs
California physician groups sued health insurer Aetna Inc. Tuesday for a slate of business practices the doctors say limit patients' choices, the latest salvo in a classic standoff between managed-care and medical practices. In February, Aetna sued some of the same doctors bringing Tuesday's allegations, saying the physicians schemed to inflate their bills to the insurer for a raft of services by nearly 800 percent, raising health care costs for members (Weaver, 7/4).

The Los Angeles Times: California Physicians Sue Aetna Over Out-Of-Network Referrals
The California Medical Assn., the largest physician group in the state, and more than 60 individual doctors sued health insurance giant Aetna Inc. as part of a growing legal battle over what patients are charged when they go outside an insurer's network. ... The suit alleges that the insurer illegally threatens doctors and patients who want to use out-of-network medical providers and then cancels the contracts of some physicians who persist in those referrals (Terhune, 7/4).

Bloomberg: Aetna Suit by Doctors Escalates Out-of-Network Dispute
Earlier this year, Aetna sued six California surgery centers not in its network, alleging they paid illegal kickbacks to doctors and charged too much for health care. In the new lawsuit against Aetna, the doctors and medical groups allege that Aetna violates state fair-business and false- advertising laws by selling insurance policies that allow for out-of-network care, and then intimidating doctors and patients to keep them from gaining access to the benefits (Waldman and Pettersson, 7/5).

San Jose Mercury News: Doctors' Suit Against Aetna Claims Patients Denied Specialized Care
The lawsuit alleges one patient bought a Preferred Provider Organization plan from Aetna for services by in and out-of-network care, and was not fully reimbursed after he received a medically necessary surgery performed by a physician outside the network. The lawsuit claims he was reimbursed $9,000 of $70,000 in medical bills (Abram, 7/3).

Modern Healthcare: Calif. Medical Association, Docs Sue Aetna
Aetna sued many of the same doctors and ambulatory surgery centers in February in Santa Clara County (Calif.) Superior Court, alleging that the doctors were illegally waiving their fees and inducing patients to receive overly expensive procedures at out-of-network facilities owned in part by the physicians themselves (Carlson,  7/3).