Aetna Wins NJ Surgical Center Coverage Row

Law360, New York (May 23, 2013, 2:50 PM EDT) -- Aetna Health Inc. on Wednesday defeated a lawsuit filed by an outpatient surgical center claiming the insurer's refusal to cover procedures violated the Employee Retirement Income Security Act, when a New Jersey federal judge ruled Aetna's decision was supported by substantial evidence.

Montvale Surgical Center LLC said Aetna's refusal to cover an injection treatment for an Aetna participant was “arbitrary and capricious” and alleged that the insurer had a blanket policy of denying that kind of treatment. Aetna said it based its determination on published medical...
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