Aetna Must Face Suit Over National Advantage Program Payments

Three breast cancer patients advanced a proposed class action accusing Aetna Inc. of improperly underpaying claims for medical services performed at in-network facilities by out-of-network providers.

The patients can move forward with benefit claims accusing Aetna of failing to properly cover “involuntary services” as required by their Employee Retirement Income Security Act health plans, the US District Court for the District of New Jersey ruled Wednesday.

The parties disagreed over whether the patients’ breast reconstruction surgeries satisfied their health plans’ definition of involuntary services, which would allow them to be covered similar to in-networks services despite being provided by out-of-network ...