Aetna Health Avoids California Doctor Group’s Referral Suit

April 28, 2021, 11:50 PM

A California physician’s group failed to allege it was directly harmed by Aetna Health’s out-of-network referral policy, and therefore can’t seek an injunction under the state’s unfair competition law, an appellate court said Wednesday.

The California Medical Association alleged that agreements between Aetna and member doctors required the use of in-network providers to the fullest extent possible, consistent with sound medical judgment.

Aetna threatened physicians that the use of out-of-network facilities might be considered noncompliance with the agreement, and told them that referrals to out-of-network providers would result in a warning placed on the physician’s profile on Aetna’s website, CMA...

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