AMA joins Georgia lawsuit against Aetna
The American Medical Association (AMA) has joined the Medical Association of Georgia in a class action lawsuit against Aetna U.S. Healthcare for failure to pay physician claims in a timely manner.
The suit, filed in Fulton County Superior Court in Atlanta, charges that Aetna routinely delays payments of claims in violation of Georgia’s prompt payment law and that the insurer is unjustly enriched by using the money due physicians for its own profits.
It is the first time that the AMA has joined with a state organization to sue an insurer, but it is not likely to be the last time, an AMA spokesman says. The AMA joined the lawsuit through its Litigation Center, a partnership between the AMA and 49 state medical societies.
"It’s time that insurance companies honor their contracts and pay physicians in a timely manner so that patients can continue getting the care they deserve," says Donald J. Palmisano, MC, a member of the AMA board of trustees.
Georgia’s prompt payment law mandates that clean claims must be paid within 15 working days. If the claims are not paid within those 15 days, the insurance company must send written notice to the provider stating the reason for nonpayment. After the 15-day period, the insurer must pay an 18% per year late fee to providers.
"By delaying payment of a claim, Aetna increases the time it retains the funds due to the health care provider who has submitted the claim. Meanwhile, Aetna earns profits from use of the funds, profits that it would not earn if payment were made in a timely manner," according to the lawsuit.
Payment, plus interest
The suit asks for damages to the plaintiffs to compensate them for the unpaid claims along with 18% interest and an injunction preventing Aetna from continuing to delay payment of claims. "Through this lawsuit, we hope Aetna and other insurance companies understand that physicians, on behalf of their patients, are no longer to accept harmful business practices. Delaying payment of claims hurts Georgia’s physicians by making payment for services rendered uncertain. Patients are also hurt. Some patients have lost their physicians because of Aetna’s payment policies," says Paul Shanor, executive director of the Medical Association of Georgia.
A copy of the suit is available at the Medical Association of Georgia’s Web site: http://www. mag.org.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content