Aetna sued by group of Western Pa. hospitals
A consortium of eight Western Pennsylvania hospitals and more than 400 doctors who collaborate in improving care and holding down health care costs is suing Aetna Network Services LLC for breach of contract, alleging the health insurance giant is tucking extra costs into their agreement that boosts Aetna’s plan enrollment.
Bridges Health Partners LLC, a Marshall-based nonprofit, filed a one-count lawsuit in Allegheny
Common Pleas Court on Tuesday that seeks declaratory and injunctive relief and cites multiple breach of contract claims in a three-year agreement that was signed in 2023.
Officials at the Hartford, Conn.based insurer declined to comment on the lawsuit Wednesday.
Independence Health System, Washington Health System, St. Clair Health and McCandless-based physicians’ practice Genesis Medical Associates Inc. use Bridges Health to try to reduce medical costs while improving overall care by better managing the delivery of care in doctors’ offices, hospitals, nursing homes and other facilities.
The consortium represents more than 1,000 doctors who care for thousands of patients, including nearly 23,000 Aetna plan members in Western Pennsylvania.
In February, Bridges Health inked a deal with Highmark Blue Cross Blue Shield to represent commercial health insurance members. It had reached an agreement in 2022 that covers Highmark’s Medicare Advantage plan members.
In 2022 alone, Bridges Health claims to have saved $5.6 million in health care costs, splitting the savings among its members.
The lawsuit alleges that Aetna added supplemental benefit costs — such as marketing expenses that included gift cards, over-the-counter medications, meals, and gym memberships for patients — that were subtracted from money that otherwise would be spent caring for patients. The medications and gift cards could only be purchased or used at stores owned by CVS Health, Aetna’s corporate parent.
The consortium seeks injunctive relief to force Aetna to abide by terms of the contract, reimburse funds that it believes it is due and pay legal fees.
“Health plan organizations like Aetna are setting record profits while community-based hospitals and health systems are struggling,” John Grese, Bridges Health vice president, said in a prepared statement. “If the insurance agency corporate giants are not stopped, community health care will be obsolete, putting thousands of doctors, nurses and staff out of jobs and the very people needing treatment will be the ones who suffer.”
Central to Bridges’ business model is participation in an accountable care organization, a program Medicare rolled out in 2012 to reduce treatment costs without sacrificing quality of care. The plans give doctors and hospitals the opportunity to share in savings that are achieved through better coordination and preventive treatment.
Since then, Bridges Health has partnered with insurers to achieve similar savings.
Bridges Health, which serves 120,000 patients in 13 counties across Western Pennsylvania, is represented by the Downtown law firm of Lynch Carpenter LLP and New York City-based Scott+Scott Attorneys at Law LLP.