A Mount Kisco psychiatrist claims that Aetna health insurance is endangering patients by illegally refusing to pay for his services.
Dr. Aaron D. McDaniel and New York Metropolitan Psychiatry accused Aetna Better Health Inc. of violating the New York Prompt Pay Law, in a complaint filed on Jan. 16 in Westchester Supreme Court.
“Unless stopped by this court,” the complaint states, denying payments will impair Dr. McDaniel work, “placing his patients’ health and well-being at risk.”
Aetna routinely paid McDaniel for patient services until September 2024, according to the complaint. Since then, Aetna has refused to pay $102,371 for psychiatric services for 116 patients.
Under the state’s Prompt Pay Law, claims must be paid within 45 days, McDaniel says. If a payment is withheld, the insurer must identify specific reasons. But despite requests for clarifications, Aetna allegedly provided no explanations for withholding payments.
Instead, Aetna placed the medical practice on “prepayment review” and demanded patient records.
After Aetna received the records, an investigator allegedly responded that treatment notes were not signed; start and stop times and the place of service were not recorded; credentials of the healthcare providers were not included; and handwritten records had to be typed.
McDaniel claims he diligently complied with each record request.
He believes that prepayment review is “an excuse to deny claims on baseless or unsupported grounds, to minimize reimbursements.”
McDaniel treats patients with complex psychiatric diagnoses. Without his services, “these patients risk intensive psychiatric hospitalization, relapse or suicide.”
As patients discovered that Aetna was not reimbursing McDaniel’s medical practice, they “had to make the difficult decision about whether to stay and pay for services entirely out-of-pocket, or to find other care.”
Several patients who could not afford to pay for everything sought help from nurse practitioners and physician assistants.
Patients who stayed with McDaniel and submitted claims to Aetna on their own have received reimbursements, indicating, the complaint states, that Aetna is targeting McDaniel alone.
Besides alleged violations of the Prompt Pay Law, McDaniel accused Aetna of breach of contract, interference with business relationships, and breach of good faith and fair dealing. He is demanding payment for all claims submitted since Sept. 1, 2024; unspecified monetary and punitive damages; and an order stopping Aetna from continuing to audit his medical practice.
Attorneys for Robinson & Cole law firm in Manhattan, who are representing Aetna, did not reply to a message asking for their client’s responses to the allegations.
