Aetna circumvented obligations to cover out-of-network COVID-19 diagnostic testing, lawsuit alleges

A proposed class action lawsuit was filed against Aetna Healthcare of California May 16 alleging the insurer evaded its obligations to fully cover COVID-19 diagnostic testing. 

The lawsuit was filed by Saloojas, an out-of-network laboratory that operates seven specimen collection sites. The company said the insurer is required to fully cover all Aetna Plan members' COVID-19 diagnostic testing services and issue reimbursements during the public health emergency, regardless of network status. 

Saloojas alleges Aetna mis-adjudicated "almost every single" COVID-19 testing claim it submitted on behalf of Aetna plan members and denied a vast majority of COVID-19 testing claims the company submitted. 

The company alleges that Aetna's actions undermined national efforts to mitigate the spread of COVID-19 and caused the company and others to shutter specimen collection and testing locations and potentially stop offering COVID-19 testing services altogether. Saloojas alleged Aetna's misprocessing and denials have caused the company near insurmountable financial loss. 

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