Aetna's War on Patients

In Gordon, et al. v. Aetna Life Insurance, filed in the District of Connecticut on September 24, 2024, plaintiffs alleged that Aetna violated Section 1557 of the Affordable Care Act by denying coverage for medically necessary gender-affirming facial surgeries.

The lawsuit revealed that transgender patients were forced to pay out-of-pocket costs ranging from $35,000 to $50,000 after Aetna wrongfully classified these medically necessary procedures as "cosmetic." The case seeks both injunctive relief to end Aetna's exclusionary policy and compensatory damages for affected policyholders.

They denied essential healthcare to transgender patients through discriminatory policies that ignored medical necessity.

The California Medical Association (CMA) challenged Aetna Health of California Inc.'s practice of harassing and terminating physicians who referred PPO members to out-of-network providers, leading to a significant California Supreme Court ruling on December 18, 2024.

The court ruled that CMA had legal standing to sue under the Unfair Competition Law, validating claims that Aetna's policies interfered with the doctor-patient relationship and violated state laws designed to protect patient choice and provider autonomy.

They intimidated physicians to restrict patient choice and maintain control over healthcare decisions.

In Goidel v. Aetna, LGBTQ+ plaintiffs challenged Aetna's discriminatory fertility coverage policies that imposed higher costs and longer waiting periods compared to heterosexual couples, leading to a preliminary settlement approval on October 10, 2024.

The settlement established a $2 million fund for affected class members and required Aetna to revise its fertility coverage policies to ensure equitable access for all families, regardless of sexual orientation or gender identity.

They created financial barriers that discriminated against LGBTQ+ families seeking fertility treatments.

A class-action lawsuit filed in the Central District of California on September 24, 2021, alleged that Aetna violated the Mental Health Parity and Addiction Equity Act (MHPAEA) by using overly restrictive criteria for mental health residential treatment coverage.

The lawsuit exposed how Aetna systematically denied claims based on facility accreditation requirements that were never applied to physical health services, creating an illegal double standard in coverage determinations. The case sought reprocessing of denied claims and implementation of equitable coverage standards.

They created arbitrary barriers to mental health care while rubber-stamping physical health claims.

Multiple lawsuits filed in New Jersey federal court on October 27, 2023, revealed that Aetna had agreed to cover bilateral breast reconstruction at in-network rates but later paid only a fraction of the costs after surgeries were completed.

These practices left breast cancer patients with significant unexpected out-of-pocket expenses following mastectomies, highlighting systemic issues in Aetna's claims processing and payment policies for critical post-cancer care.

They abandoned breast cancer survivors with massive bills after promising full coverage for reconstruction.

AlexSam filed a lawsuit against Aetna alleging infringement of its '608 patent related to VISA and Mastercard products used in healthcare transactions. The case, initially filed on June 28, 2019, reached a critical point with an appeal decision on October 8, 2024.

The district court dismissed the claims based on licensing agreements that protected Aetna's use of the patented technology. AlexSam's appeal faced procedural challenges and was ultimately dismissed due to insufficient allegations against Aetna subsidiaries.

They defended against patent claims through complex licensing agreements and corporate structures.

The American Medical Association (AMA) strongly opposed the CVS-Aetna merger, arguing it would harm competition in pharmacy benefit management (PBM), retail pharmacy, and Medicare Part D markets, leading to increased premiums and reduced quality of care.

Despite the AMA's objections highlighting risks of reduced consumer choice and increased costs, Federal Judge Richard Leon ultimately approved the Department of Justice settlement on September 18, 2024, allowing the merger to proceed.

They consolidated power across healthcare sectors despite warnings of harm to patient care and costs.

Kansas officials terminated Aetna's participation in the state's Medicaid program (KanCare) due to persistent issues with provider credentialing and payment delays. The decision affected hundreds of thousands of beneficiaries and highlighted systemic issues in Aetna's Medicaid operations.

In response, Aetna filed suit alleging that destroyed documents compromised their ability to appeal effectively. However, state officials maintained that Aetna's track record of performance issues justified their exclusion from future contracts.

Their mismanagement of Kansas Medicaid services led to their removal from a major state program, affecting vulnerable populations.

A father filed suit against Aetna in U.S. District Court on February 14, 2024, after facing repeated denials for his daughter's inpatient mental health treatment under ERISA guidelines, highlighting the company's systematic failure to provide adequate mental health coverage.

The lawsuit alleged that Aetna failed to provide adequate justification for claim denials under plan terms, seeking both damages for immediate harm and injunctive relief to address systemic violations affecting mental health coverage across their plans.

They denied critical mental health care while failing to justify their decisions under ERISA requirements.

In Berton v. Aetna, filed in March 2024, plaintiffs challenged Aetna's discriminatory fertility coverage policies that required LGBTQ+ families to pay out-of-pocket for multiple rounds of artificial insemination before accessing full fertility benefits.

The ongoing lawsuit revealed that heterosexual couples were not subjected to the same requirements, creating an inequitable system of access to fertility treatments. The case seeks injunctive relief to eliminate discriminatory practices, compensation for affected individuals, and comprehensive policy revisions.

They created financial barriers that discriminated against LGBTQ+ families pursuing parenthood.