ROSELAND, N.J./February 15, 2011 -- Liza M. Walsh, Patricia A. Lee, and Neil V. Shah secured a dismissal for Aetna Life Insurance Company in New Jersey Superior Court, Middlesex County, in a suit filed by the New Jersey Dental Association (NJDA) on behalf of its member-dentists. NJDA challenged provisions in Aetna’s network dental agreements that established maximum fees dentists could charge Aetna insureds where no payment was due under the Aetna plan. While so-called “non-covered services” provisions have been the target of a concerted lobbying effort in other states, NJDA attempted to bypass the legislative process, and have the Court declare that Aetna’s network dental agreements violated existing regulations governing selective contracting arrangements.
On January 31, 2011, an opinion entered by Hon. Bryan D. Garruto rejected NJDA’s request for declaratory relief and granted the Motions to Dismiss filed by both Aetna and its co-defendant, Metropolitan Life Insurance Company. The Court held that the statutory scheme did not give NJDA a private right of action to challenge these provisions and further that state law provides insurers with the ability to set fee arrangements for non-covered services. The decision is a major victory for dental insurers in New Jersey, as it affirms their ability to provide cost savings to their insureds without increasing dental premiums.
Patricia Lee is a member of the firm’s Commercial Litigation and Healthcare/ERISA Litigation practice groups.
Neil Shah is a member of the firm's Commercial Litigation practice group.