$66,100 Bunion Treatment Lands 7 Surgery Centers in Court

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The cost of healthcare continues to increase in the United States, even as healthcare reform laws are hotly debated in Washington.</p>
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But in one recent case, the cost of a bunion repair raised enough red flags to spur Aetna to file a lawsuit against seven surgery centers in California. The $66,100 claim was called into question for obvious reaons, and <a href="http://www.sccaseinfo.org/pa6.asp?full_case_number=1-12-CV-217943&amp;crumbs=Civil_Index&amp;crumbs=Case_Number_Search&amp;crumbs=Case_Number_Results">Aetna&rsquo;s lawsuit</a> claims that the billing system &ldquo;recklessly subverts&rdquo; the delivery of healthcare with the outrageous charges.</p>
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&ldquo;Failure to recognize this historical out-of-network avalanche will result in shocking financial disasters, as experienced by so many hospitals in 2003, faced with class actions by patients in almost all 50 states and most State Attorney Generals for alleged Hospital &lsquo;Price Gouging,&rsquo; when the hospitals were aggressively collecting full charges from uninsured and underinsured patients,&rdquo; says Dr. Jin Zhou, President of <a href="http://erisaclaim.com/">ERISAclaim.com</a>, &nbsp;and a national expert on PPACA and ERISA appeals and compliance.</p>
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Aetna&rsquo;s suit asks the court to force the centers to stop waiving co-insurance payments patients should be charged when they use out-of-network doctors or facilities. Essentially, the centers are accused for illegally luring patients with the promise of a free co-pay. They then billed Aetna as much as 2,500 percent more than what the insurer pays contracted providers, the lawsuit states.</p>
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Whether or not Aetna wins its case, it seems to be one more indicator that a new frontier is being built in this country&rsquo;s healthcare history.</p>
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The &ldquo;scheme must be promptly declared illegal to preclude its continuation and replication throughout California, and to avoid the potential consequences of irreparably damaging a system of healthcare delivery on which millions of citizens rely,&rdquo; according to Aetna&rsquo;s complaint.</p>
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&ldquo;Aetna may or may not prevail in the court of law with these allegations,&rdquo; Zhou says. &ldquo;But meanwhile, what are we supposed to do if we have 77% of insured Americans in private sector who paid for the expensive out-of-network premiums for coverage but now can&#39;t afford to pay 100% of escalating deductibles and coinsurance?&rdquo;</p>
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