California's highest court has revived a high-profile lawsuit that could have a major impact on whether insurers can punish physicians who refer patients to out-of-network providers.
July 25, 2023
Out-of-network providers and clinics were involved in just 4.7% of professional medical claims in 2020, according to a The case, filed in 2012, alleges that Aetna harmed patient care by harassing and sacking contract physicians who referred patients to out-of-network ambulatory surgery centers. In an interview, research professor emeritus Jack Hoadley, PhD, of the Health Policy Institute at Georgetown University's McCourt School of Public Policy, noted that many health plans don't cover out-of-network care. Those that do ― including PPOs and hybrid plans ― often require that patients pay a larger share of the total cost or pay a separate or higher deductible, he said.
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