Practitioner Alleges Aetna Bermuda Claim Delays Led to Bankruptcy

An adversary case was filed Wednesday in association with the bankruptcy filing for Dr. S. Dayyani, OD, an optometric services provider , against Aetna Bermuda. The case, filed in Bankruptcy Court for the Central District of California, alleges that Aetna is a third party against whom the debtor has a cause of action and as a non-priority unsecured creditor. The case claims that Aetna’s business practices are the major cause of the debtor filing for bankruptcy as a result of Aetna’s coverage practices.

The plaintiff is an optometric services provider in the Los Angeles area. Among the plaintiff’s patients, the complaint explained, were a substantial number of students from the Saudi Arabian Cultural Mission, who received their American insurance coverage through Aetna Bermuda. In addition to the routine information about coverage, the patients’ policy specifically stated that: “Aetna provides a generous health insurance benefits plan for SACM students inside and outside the U.S. SACM students are covered at 100% for medically necessary care and services.” The plaintiff routinely verified coverage, submitted claims, and then received payment from Aetna Bermuda until June 2015, when the claims started being delayed pending additional information; payments were thus also delayed. The processing of the claims was delayed until the cancellation of the policy in December 2015, resulting in claims that the payments now cannot be made. The delay and failure to pay resulted in financial insolvency for the plaintiff’s medical practice, the filing argued.

The claim alleges five causes of action, including breach of contract, breach of implied contract, a demand for payment for services rendered, quantum meruit, and a claim for open book accounts. Plaintiff seeks payment of the delayed claims, interest, and associated damages. The plaintiffs are represented by McBride Law P.C.