Aetna Sues N.J. Doctors, Pricing Central IssueBloomberg: Ultrasound At $59,490 Spurs Aetna Outrage In Suit Naming Doctors
Aetna Inc. (AET) is suing six New Jersey doctors over medical bills it calls "unconscionable," including $56,980 for a bedside consultation and $59,490 for an ultrasound that typically costs $74. The lawsuits could help determine what pricing limits insurers can impose on "out-of-network" physicians who don't have contracts with health plans that spell out how much a service or procedure can cost. One defendant billed $30,000 for a Caesarean birth, and another raised his fee for seeing a critically ill patient in a hospital to $9,000 in 2008 from $500 the year before, the insurer alleges in the suits. The Caesarean price was more than 10 times the in-network amount Aetna quotes on its website (Waldman, 3/24). This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.