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Lawsuit aims to protect patient and doctor's rights to quality healthcare and to prevent insurers from interfering with patient choice
Launching “Call to Action” campaign against insurer that puts profits before patients
The lawsuit, filed in
“Aetna is putting profits ahead of patient’s health and safety; that’s immoral and too often it is also illegal,” said
Joining LACMA and CMA as plaintiffs are the
“This lawsuit is about defending patient rights to quality care, which Aetna is ignoring,” said
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.
“We want to hear your stories and we want your employers to hear your stories so that when they choose a company to provide medical insurance services they pick one that lives up to its promises and puts patients first,” added Delgadillo. “We want Aetna to hear your stories and we want them to know that we will be telling these stories loudly: in court, in the state capital and in city halls across
Aetna Health of
LACMA and the other plaintiffs are being represented by the law firms,
The suit recounts the experience of a
“Aetna, however, repeatedly and inappropriately attempted to discourage the patient from using those benefits,”
Despite the fact that 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
The identity of the Aetna member who is a plaintiff in the complaint is being kept confidential at this time to protect his confidential health information.
The lawsuit cites the patient’s case as just one example of Aetna's illegal business practices in
Aetna advertises and sells insurance policies representing that customers can obtain health care from the physician or provider of choice when they purchase
Instead, many people who sign up for these premium policies seem to be unable to choose their own doctors despite paying for the privilege. Their doctors, in turn, grapple with threatening phone calls and cancelled contracts if they refer patients to out-of-network physicians and surgery centers.
The lawsuit comes just three months after
“Despite making tens of millions of dollars selling policies with out of network benefits,” the lawsuit says, “Aetna has engaged in a campaign to retaliate against its members who attempt to use their out-of-network benefits, and the physicians who refer these members to out-of-network providers.”
“Aetna has given us no choice,” said Delgadillo. “Aetna’s assault on patient rights and its abandonment of its promises – its contractual responsibility to patients, doctors and employers – has to be stopped.”
CMA serves more than 35,000 members in all modes of practice and specialties representing the patients of
for Hooper, Lundy & Bookman
|Copyright:||Copyright Business Wire 2012|