With federal healthcare reform still facing political head winds despite its validation by the Supreme Court, this probably isn’t the best time for health insurers to admit their utter incompetence in handling their most important role under the reform, which is keeping a lid on healthcare costs.
But that admission underlies a couple of lawsuits filed by Aetna and United Healthcare earlier this year, alleging that a Northern California chain of small surgical clinics fraudulently overcharged them tens of millions of dollars by counting on the insurers being asleep at the cost-control switch.
The clinics have joined with 60 individual doctors and the medical associations of California and Los Angeles, Ventura and Santa Clara counties in what is basically a countersuit against Aetna, filed last week in Los Angeles County Superior Court.
They say their main concern is that Aetna is preventing doctors who are themselves members of Aetna’s contract network from referring Aetna members to out-of-network clinics, in violation of the patients’ rights under their insurance policies. Don’t you believe it.
The real issues at the heart of the case are different. One is who gets paid, and how much, for your medical care.
Do you think that doctors may be driving up costs on purpose? Tell us about it in our discussion forum!
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