Mechanicsburg, Penn.-based Select Medical, a provider of long-term acute care hospitals, filed a lawsuit in October against Aetna over alleged preauthorization denials for admissions of the insurer’s Medicare Advantage members.
The complaint said Aetna denied preauthorization requests for admission for 200 of 207 and 108 of 114 patients referred to Select’s Pennsylvania long-term acute care hospitals in 2025 and early 2026, respectively. On Nov. 6, the lawsuit moved from a state court to the U.S. District Court for the Middle District of Pennsylvania.
The lawsuit claimed that “Aetna’s admission rate was the lowest among the principal payers evaluated in the Pennsylvania market during those periods.” The complaint also argued that delays and discharges to lower levels of care pose risks to patients.
“In violation of its contractual obligations to Select, Aetna has adopted an unpublished, but very real, policy of systematically denying Select’s preauthorization requests for the admission of Aetna’s Medicare members to Select’s LTCHs, including those located throughout the Commonwealth of Pennsylvania,” the complaint said.
An HHS Office of Inspector General report cited by the lawsuit said MA’s capitated payment model may incentivize care denials in an attempt to bolster plan profits. That same report found CVS Health, Aetna’s parent company, had an 80% denial rate for long-term acute care hospitals in June 2024.
Select claimed breach of contract, since MA rules bar plans from using criteria stricter than traditional Medicare, and is seeking an order for Aetna to rescind this alleged policy.
Aetna declined to comment.
