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San Jose Neurospine is battling Aetna Health California in court, alleging that the insurer illegally refused to pay for emergency medical services performed by spine surgeon Adebukola Onibokun, MD, the practice's owner.

What you should know:

1. The case centers on a two-level lumbar microdiscectomy that Dr. Onibokun performed in April 2017. San Jose Neurospine submitted two claims to Aetna for reimbursement — one for emergency medical services and one for nonemergency surgery. Aetna only provided payment for the latter.

2. San Jose Neurospine filed a civil action aga...

A federal judge could throw a wrench into the mega-merger between health giants CVS and Aetna. 

U.S. District Court Judge Richard Leon in Washington said this week he is considering delaying the $70 billion merger, and keeping the companies separate until he has a chance to weigh in. 

The move is unprecedented, as the companies were already in the process of integrating after their deal formally closed last week.

The Justice Department approved the merger in October under the condition that the companies sell Aetna’s Medicare drug business to preserve competition, and...

In 2014, when Orrana Cunningham needed proton beam therapy for stage 4 nasopharyngeal cancer, her insurer, Aetna, declined to cover the treatment. That denial, like many that occur every day in the U.S., cost Orrana and her husband, Ron, over $90,000.

The couple mortgaged their Meeker, TXOK, home to pay for the therapy. Orrana passed away the following year at the age of 54, but Aetna’s denial spawned a fight that continued until November 8, 2018, when a jury awarded Orrana’s family $25.6 million for recklessly disregarding its duty to deal fairly and in good faith...

Aetna has reached an agreement in New Jersey to pay a $365,211.59 civil penalty to settle claims that it allowed the private health information of individuals to be viewed through transparent envelope windows. The insurer will also reportedly pay $100,000 in Connecticut and $175,000 in the District of Columbia for a total of $640,000.

Aetna inadvertently disclosed the HIV/AIDS-related information on thousands of beneficiaries, including about 647 New Jersey residents, according to New Jersey Attorney General Gurbir S. Grewal, in an agreement announced October 10. 

Th...

CVS Health CVS, +1.90% today announced that it has entered into an agreement with the U.S. Department of Justice (DOJ) that allows it to proceed with its proposed acquisition of Aetna AET, +1.04% DOJ clearance is a key milestone toward finalizing the transaction, which is also subject to state regulatory approvals, many of which have been granted. CVS Health's acquisition of Aetna remains on track to close in the early part of Q4 2018.

"DOJ clearance is an important step toward bringing together the strengths and capabilities of our two companies to improve the cons...

Respiratory Sleep Solutions, LLC (RSS), a wholly owned subsidiary of the Alliance Family of Companies, LLC (Alliance), has filed suit against Aetna seeking a declaratory judgment that restores patient access to needed in-home neurodiagnostic testing. The suit alleges that Aetna has systematically violated standard coding practices for RSS-provided in-home video electroencephalogram testing (VEEG), effectively preventing patients from accessing in-home neurological testing for epilepsy and other disorders.

"Aetna is lining its pockets by denying patients neurodiagnos...

Aetna’s quest to pin the blame on someone else for exposing the HIV status of thousands of its health insurance customers ran into a cul-de-sac on Friday. Los Angeles Superior Court Judge Richard Rico dismissed Aetna’s case against Whatley Kallas and Consumer Watchdog, holding that the insurer’s claims failed under California’s anti-SLAPP prohibition on suits intended to silence or intimidate critics. Aetna still has a parallel suit against the plaintiffs’ firms under way in federal court in Philadelphia, but Judge Rico’s decision is a welcome confirmation that ant...

Drew Calver took out his trash cans and then waved goodbye to his wife, Erin, as she left for the grocery store the morning that upended his picture-perfect life.

Minutes later, the popular high school history teacher and swim coach in Austin, Texas, collapsed in his bedroom from a heart attack. He pounded his fist on the bed frame, violent chest pains pinning him to the floor.

"I thought I was dying," the 44-year-old father recalled. He called out to the only other person in the house, his oldest daughter, Eleanor, now 7. Using the voice-recognition feature on his p...

A whistleblower with Aetna who accused CVS Caremark of gouging Medicaid and Medicare customers with high prescription-drug costs has been placed on paid administrative leave by the insurance company.

The move comes after the whistleblower’s lawsuit was unsealed in federal court in early April. It also comes as CVS Caremark, one of the country’s largest pharmacy benefit managers, pursues the acquisition of Aetna for a reported $69 billion.

Sarah Behnke, at the time the chief Medicare actuary for Aetna, filed the whistleblower lawsuit, which is pending. Her attorney to...

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