Aetna Can’t Nix Out-of-Network Provider’s Reimbursement Claim

Aetna Inc. lost its attempt to escape a medical provider’s lawsuit accusing the insurance giant of underpaying for two surgical procedures rendered to a participant in an Aetna health insurance plan (McCulloch Orthopaedic Surgical Servs., PLLC v. Aetna, Inc., 2017 BL 166386, 2d Cir., No. 15-2150, 5/18/17).

The Employee Retirement Income Security Act doesn’t bar the provider’s reimbursement claim to recover $30,966 that Aetna allegedly underpaid for two knee surgeries the provider performed, the U.S. Court of Appeals for the Second Circuit held May 18. The appeals court reversed a district court decision that ERISA preempted McCulloch Orthopaedic ...