ROSELAND, N.J./June 19, 2012 -- Connell Foley’s Healthcare/ERISA Litigation practice group, including Liza M. Walsh, Marc D. Haefner, Patricia A. Lee, and Neil V. Shah, have defeated a judicial challenge to the right of its client, Aetna, and another insurance carrier, to protect its members by limiting what dental providers in its network can charge for services not covered under the dental plan.
On May 21, 2012, the New Jersey Supreme Court denied the petition for certification in New Jersey Dental Association v. Metropolitan Life Insurance Company and Aetna Life Insurance Company. The Supreme Court’s decision lets stand a February 15, 2012 published opinion from the Appellate Division, which dismissed the New Jersey Dental Association’s complaint for declaratory and injunctive relief against Aetna and MetLife. The Association’s appeal sought not only to invalidate a Department of Banking & Insurance regulation that permitted carriers to negotiate discounted rates to their insureds, but also to enjoin Aetna and Met Life from including any such discount provisions in their dental insurance plans and network provider agreements.
The Appellate Division’s ruling, and the Supreme Court’s refusal to certify the matter for appeal, enables Aetna to continue providing its insureds with affordable access to network dental care. The ruling also properly affords deference to the oversight of the DOBI Commissioner to permit parties to freely negotiate the terms of selective contracting arrangements that achieve the twin goals of New Jersey’s insurance statutes (quality of care and cost containment).
Connell Foley partners Liza Walsh, Marc Haefner, and Patricia Lee, and associate Neil Shah secured these decisions on behalf of Defendant Aetna. For more information, please call 973-535-0500 or email Patricia Lee at plee@connellfoley.com.