Aetna defends its Medicare Advantage contract for NYC retirees

Aetna is seeking to intervene in a lawsuit filed by retired New York City employees seeking to block the payer's Medicare Advantage contract with the city from taking effect. 

In a petition filed with New York County Supreme Court June 13, the company denied allegations from the retirees that Aetna's Medicare Advantage plan could subject retirees to coverage denials, higher out-of-pocket costs and more restrictive networks. 

"Since we have a vested interest and are responsible for providing coverage to retirees, we are uniquely positioned to address the inaccurate statements and misinformation that have created unnecessary fear and anxiety among the community and caused questions about the plan," Rick Frommeyer, senior vice president for Aetna group retiree solutions, said in a statement shared with Becker's. 

In an affidavit filed with the court, Mr. Frommeyer said 3.4 percent of claims in Aetna's Medicare Advantage plans were subject to prior authorization, and 0.49 percent were denied. 

In the lawsuit, filed May 31, nine retirees and the NYC Organization of Public Service Retirees allege providing Medicare Advantage as the only option for retirees violates the city's obligation to provide health benefits to its retired workers. 

Retired workers can opt out of the Medicare Advantage plan for traditional Medicare but will have to pay for any supplemental coverage out of their own pockets. 

On June 8, New York City comptroller Brad Lander said he would block implementation of the contract while the lawsuit is ongoing. 

"As a matter of public policy, beyond the scope of our office's specific [city] charter responsibility for contract registration, I am seriously concerned about the privatization of Medicare plans, overbilling by insurance companies, and barriers to care under Medicare Advantage," Mr. Lander said in a June 8 news release. 

The contract, which covers 250,000 retired city employees and their dependents, was set to take effect Sept. 1.

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