PSYCHOLOGISTS: Sue Aetna For False Advertising
The California Psychological Association filed suit yesterday against Aetna U.S. Healthcare of California Inc., charging that the nation's largest HMO engages in false advertising, routinely disregards practitioner determinations of medical necessity and purposefully delays processing treatment authorization requests. Specifically, CPA contends that Aetna's Select Choice HMO misleads California consumers, claiming to offer prompt, accessible mental health treatment services that the CPA says are not provided. Through advertisements, Aetna claims that enrollees are offered 20 to 50 outpatient visits per year with contracted mental health providers. But the CPA asserts that the contracted provider organizations impose an undisclosed four-visit limit on the benefit (American Psychological Association release, 9/28).
The 5,000-member CPA filed suit in California Superior Court, alleging that Aetna's actions violated three California laws: the Unfair Competition Act, the False Advertising Statute and the Consumer Legal Remedies Act. In addition, CPA charges that those psychologists who attempt to secure "additional treatment are dropped by the plan, which violates a state law that prohibits retaliation for patient advocacy" (Allen, AP/Contra Costa Times, 9/29). Russ Newman, executive director for professional practice for the American Psychological Association, said of the suit, "These are serious allegations in which a managed care company is utilizing deceptive practices that harm patients and undermine laws designed to protect consumers in order to increase profits" (APA release, 9/28). John McDermott, attorney for the California psychologists, said, "We want to send a message that if you play these games, we're out there looking at you. We're going after what is widely regarded as the worst HMO in the state to force them to change their practices" (Maharaj, Los Angeles Times, 9/29). An Aetna spokesperson refused to comment on the suit until the company reviews the court filing (AP/Contra Costa Times, 9/29).
The APA is also supporting a New Jersey Psychological Association lawsuit against MCC Behavioral Health Care. The NJPA filed the complaint after MCC terminated psychologists from its provider network "without cause." Allegedly, psychologists were terminated for asserting professional judgement and patient advocacy. The NJPA charges this practice poses a serious threat to public welfare (APA release, 9/28).