Challenging Providers: A Health Plan Flexes Its Muscle

Law360, New York (March 19, 2012, 1:48 PM EDT) -- In a lawsuit filed in Harris County, Texas, in December 2011, Aetna Health Insurance Inc. took on the issue of out-of-network discounts provided by physicians and other facilities to the patient financial obligation — copayment and deductible requirements — as well as the tie between the out-of-network discount to ownership interests held by physicians in the out-of-network facility.

Tension between the hallmarks of managed care — volume and steerage in the creation of tightly managed delivery networks — and freedom of choice and medical professional decision-making...
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