California Medical Association Calls on Aetna to Stop Retaliatory Behavior Against Physicians

News provided by

Aug 30, 2012, 02:44 ET

SACRAMENTO, Calif., Aug. 30, 2012 /PRNewswire-USNewswire/ -- In response to a lawsuit filed earlier this summer, Aetna Life Insurance Company and its local subsidiary, Aetna Health of California (Aetna), have engaged in retaliatory actions against California Medical Association (CMA) physician members by terminating contracts or abruptly ending contract negotiations.

Plaintiff attorneys in Los Angeles County Medical Ass'n et al. v. Aetna Health of California, Inc. et al. sent a letter to Aetna attorneys earlier this week asking that the insurer cease and desist all actions of retaliation that appear to be a direct result of the lawsuit filed in July. CMA also sent a request to Aetna leadership.

The lawsuit contends that Aetna's policies and practices amount to unfair business practices, false advertising, breach of contract and illegal retaliation. CMA's primary objective in the lawsuit is to compel Aetna to conform its business practices to state and federal laws, which prohibit health insurers from directly or indirectly denying access to out-of-network covered services under policies with out-of-network benefits.

"We're confident in the merits of our claim," said James T. Hay, M.D., CMA president. "Regardless of Aetna's position in the ongoing litigation, they must stop the retaliatory actions against physicians. Terminating contracts and ending negotiations will only shrink Aetna's network of physicians and patient access to care will be severely impacted."

Since the lawsuit was filed, Aetna is categorically refusing to negotiate or contract with any physician to join Aetna's provider network if the physician is a member of CMA, citing the fact that CMA has sued Aetna.

"Aetna is essentially saying that they will no longer do business with the 35,000 members of CMA," said Dr. Hay. "They should be looking to expand their provider network to meet the growing demands of California's health care needs."

In addition to these retaliatory actions, it appears Aetna has escalated the unlawful practices that are the subject of the LACMA litigation.

"Physicians who are named plaintiffs in the lawsuit, as well as those who have no direct involvement, are now being faced with termination from the Aetna network," added Dr. Hay. "Referring to out-of-network services is not a breach of contract, but rather part of the benefits that patients are purchasing with a PPO product. Aetna's actions are uncalled for, no matter which way you slice it."

SOURCE California Medical Association