Last week, the California Medical Association and Aetna sent letters to each other as part of an ongoing dispute involving lawsuits related to physician conflicts of interest and patient access to out-of-network doctors, the Sacramento Business Journal reports.
Background
In February, Aetna filed a lawsuit against a surgery center company in the South Bay Area, seven surgery centers and principal physicians for allegedly sending Aetna members to the facilities without informing them that the doctors practicing there had financial interests in the business (Robertson, Sacramento Business Journal, 9/5).
In July, CMA -- along with more than 60 individual physicians in California -- filed a lawsuit against Aetna for allegedly threatening to deny patients' coverage of services provided by out-of-network physicians, even if their plan allows them to visit such doctors.
According to the lawsuit, Aetna also has threatened to terminate member physicians' contracts if they refer patients to out-of-network health care providers (California Healthline, 7/5).
Aetna officials said that they consider the CMA lawsuit to be an act of retaliation for the insurer's earlier lawsuit.
Details of Letters
Last week, CMA sent a letter to Aetna lawyers saying that the insurer is retaliating against the association's members in response to the lawsuit that the association filed in July. According to CMA, Aetna is refusing to negotiate or contract with any physician belonging to CMA.
A day later, Aetna sent a letter to CMA saying that it is not opposed to negotiating with CMA members who provide quality care and conduct themselves ethically. However, the insurer said it is limited in its willingness to negotiate with physicians who it has sued (Sacramento Business Journal, 9/5).