Phoenix-based Fortitude Surgery Center has filed a lawsuit against Aetna, alleging violations of federal retirement income policy by denying claims for medically necessary services, according to court documents obtained by Becker's.
The lawsuit, filed Oct. 1 in an Arizona federal district court, accuses Aetna of "continuous and systematic denial of healthcare reimbursement claims" for services administered to patients insured by Aetna or for plans under the Employee Retirement Income Security Act of 1974.
"Aetna’s conduct is another example in a pattern of retributive behavior for perceived disputes between Aetna and certain of Fortitude's owners arising out of reimbursement claims from unrelated pain management provider entities," the suit said.
According to the allegations, an Aetna patient received medically necessary, nonsurgical pain management services at the ASC. Since the center was not in-network, it followed a process for each rendered service to ensure payment. The suit claims that not only did the ASC confirm with Aetna that the procedure would be covered, but it also received prior authorization.
For each of the unpaid claims, the ASC submitted a bill to an Aetna, who began "serially denying payment."
The suit also alleges Aetna breached ERISA plan provisions by failing to provide the Aetna members or their assignees the benefits due to them under the terms of their plans.
Fortitude Surgery Center is seeking compensatory damages, restitution and punitive damages, among other requests.
Becker's has reached out to Aetna and will update the story if more information becomes available.