Tag Archives: out of network

Insurer Actions Cut the Heart Out of Out-of-Network Providers

By Robert M. Wolin on April 26, 2016 Posted in Uncategorized

Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged out-of-network overbilling scheme and kickbacks to referring physicians. This lawsuit is simply one more effort in a larger trend by insurers to make it more … Continue Reading

Texas Surgical Centers: Aetna Improperly Denies or Underpays Out-of-Network Claim

By John W. Petrelli and B. Scott McBride on September 30, 2015 Posted in Uncategorized

Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special Surgery) filed suit in Harris County District Court against Aetna Health Inc. and Aetna Life Insurance Company (Aetna), claiming that Aetna underpaid or … Continue Reading

Texas Hospital Strikes Back at Aetna

By B. Scott McBride, Darby C. Allen and John W. Petrelli on August 31, 2015 Posted in Uncategorized

On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership stakes in the 139-bed community hospital in exchange for patient referrals and designed an out-of-network business strategy that gave rise … Continue Reading