Hartford, Conn.-based Aetna is being hit with a proposed class-action lawsuit for allegedly using a restrictive definition of "medically necessary" to avoid covering a patient's physical therapy.
Court documents filed March 15 in the U.S. District Court for the District of Connecticut say that Aetna must argue against allegations that it violated the Employment Income Retirement Security Act through its coverage limits. Aetna enrollees under an employment plan would be eligible for the potential class action.
The plaintiff in the lawsuit is Dennis Curtis, who received health coverage from New Haven, Conn.-based Yale University. Aetna is contracted with the school to administer the plan and benefits.
Mr. Curtis' original 2019 complaint was dismissed last year by Judge Michael P. Shea, but the judge accepted his amended complaint on Tuesday.
Aetna had originally argued that Mr. Curtis could not have physical therapy covered under the Yale Plan because his diagnosis would not ''significantly improve'' with therapy, and therefore was not ''medically necessary."