Roy Liddell Successfully Defends Managed Care Company In Claims By North Carolina Medical Provider

Wells Marble’s Roy Liddell represented Aetna Health of the Carolinas, Inc., Aetna Life Insurance Company and Aetna Health Management, Inc. (collectively, “Aetna”) in claims asserted by an oral surgeon in Charlotte, North Carolina for allegedly under-reimbursing for medical procedures.
The doctor’s claims were presented through arbitration and involved over 100 separate claims for treatments provided by the doctor. The doctor claimed that Aetna breached its contracts and violated various North Carolina statutes by “cross walking” claims to a code that resulted in a less favorable reimbursement. After hearing evidence, the arbitrator rejected the doctor’s claim that Aetna had manipulated reimbursements to its advantage and held that Aetna had not violated its contracts or any statutory provisions. The doctor’s claims were dismissed
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