Latest Class Action Alleges Prudential Mishandles Patient Care
The plaintiffs' bar continues to target managed care companies, with Prudential Insurance Co. of America becoming the latest insurer hit with a class action. The Newark, N.J.-based health insurance giant and its health care subsidiaries join ranks with Aetna U.S. Healthcare Inc., United Health Group and other insurers that have come under fire for their managed medical care practices.
The latest federal class-action lawsuit, filed April 11 in the U.S. District Court of New Jersey, may affect several million people who are covered by Prudential employee benefit plans and/or those who receive coverage under certain Aetna health plans. Aetna acquired Prudential's health insurance units last year.
The suit alleges, among other things, that PruCare breached the terms of its health care plans by using procedures for determining whether proposed care is "medically necessary" that are inconsistent or conflict with generally accepted medical standards, according to the two law firms who brought the class action.
The plaintiffs' attorneys point to Aetna's settlement last week with the Texas Attorney General as evidence of the formation of a new standard for determining what care is medically necessary. "Among other things, Aetna agreed that 'the determination of medically necessary care is an analytical process that will be applied by Aetna on a case-by-case basis by qualified professionals,'" the attorneys said in a statement announcing the Prudential lawsuit.
"In the recently filed Prudential action, plaintiffs allege that their contracts require PruCare to follow this standard and that it has failed to do so. The plaintiffs seek to compel PruCare to comply with its contractual obligations on a nationwide basis, as Aetna has now agreed to do in Texas," the plaintiffs' attorneys said in the statement.
In its settlement, Aetna also agreed to peer review or publicly disclose any non-case specific guidelines or policies it uses to determine medical necessity. The lawsuit against Prudential seeks similar actions, alleging that PruCare relies on guidelines supplied by consultant Milliman & Robertson, and that those guidelines "have neither been disclosed nor been made available for peer review."
Two law firms, Pomerantz Haudek Block Grossman & Gross LLP and Milberg Weiss Bershad Hynes & LeRach LLP, are representing the plaintiffs in the PruCare class action.