Court Dismissed Aetna’s Out-Of-Network Lawsuit against Texas In-Network Physicians- ERISAclaim.com Demystifies
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Case info:
Today, ERISAclaim.com announced a new ERISA and PPACA Patient Advocacy Program with compliance for reimbursement and freedom of choice, to timely discuss and demystify all important court decisions, such as this Texas Aetna decision, and to inform physicians of the in-depth judicial guidance, in order to better protect all patients and physicians in seeking for out-of-network quality healthcare.
"This court decision is significant for more than 76% of the insured patients who paid for out-of-network coverage under all employer-sponsored health plans in USA, when exercising their freedom of choice of the network physicians. This decision is also vital to the nationwide epidemic overpayment recoupment war between the payers and providers," says Dr.
http://stats.bls.gov/ncs/ebs/detailedprovisions/2012/ownership/private/table02a.pdf
http://stats.bls.gov/ncs/ebs/detailedprovisions/2011/ownership/private/table02a.pdf
http://stats.bls.gov/ncs/ebs/detailedprovisions/2010/ownership/private/table02a.pdf
"Although Aetna's claims were dismissed with prejudice for two
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Without any detailed discussion, the court orders the following in part:
"It is, therefore, ordered that Defendants' Plea to the Jurisdiction as to all of the Plaintiff's claims except the claims for equitable accounting is granted and all such claims against Defendants Ifeolumipo O. Sofola, M.D., Michael L Blackwell, M.D.,
The court dismissed the following Aetna original claims with prejudice in part:
"Count One (injunctive relief): 19. Defendants are engaging in practices that violated
"Count One (Injunctive Relief): 22. A permanent injunction is proper because: (i) there will be needed and irreparable harm if Drs. Blackwell and Sofola continue to refer Aetna member patients to out-of-network facilities in exchange for receiving a percentage of hospital's facility fees as kickbacks; (ii) Aetna has no other adequate remedy at law; (iii) a greater injury will result from denying the injunction than from its being granted; and (iv) the injunction will not disserve the public interest., according to court document.
"Count Three (Money Had and Received): 30.
A copy of the original Aetna Complaint was attached with this press release with its "equitable accounting" claim.
To find out more about ERISA & PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm
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For any questions, please contact Dr.
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