East County News Service

July 17, 2023 (Sacramento) -- The California Medical Association (CMA) has achieved a significant victory for healthcare providers, consumers and public interest advocates in the case of California Medical Association v. Aetna Health of California Inc. The California Supreme Court ruled unanimously in favor of CMA, confirming  the organization's legal standing to sue Aetna Health for alleged violations of the Unfair Competition Law (UCL).

The lawsuit centers on an Aetna Health policy that targeted the use of out-of-network benefits by its PPO plan members. CMA alleges that the insurance company discouraged its members from going out of network even though their PPO plans included such benefits, and that Aetna Health harassed or terminated its contracted physicians for referring PPO members to out-of-network facilities.

Such a policy, according to CMA, directly interfered with the doctor-patient relationship and physicians’ independent medical judgment, in violation of numerous state laws. CMA sued Aetna Health to stop what it calls “harmful and illegal policy.”