Helping Aetna get religion: Doctor panel gives insurer a chance for salvation

Thanks to the insurer's settlement of a class-action lawsuit, doctors now can speak their piece directly. Nothing may change soon, but it's an encouraging sign.

Posted Feb. 2, 2004.

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As any preacher knows, the target of evangelizing doesn't always respond the way you'd like. But at least you have a better shot than if that target never came to church.

So it's a positive step that on April 2, a committee of physicians and representatives of Aetna are scheduled to come together for the first of a regular series of face-to-face meetings -- at least two per year -- intended to bring the wayward company some religion.

The committee isn't expecting a miracle conversion, but it's willing to try. By filling in Aetna on the gospel of how physicians operate, the committee has a better chance than physicians ever had of effecting some sort of change on a company that many physicians feel has been ignorant of the Good Book -- the CPT manual, that is.

Aetna isn't totally a voluntary parishioner. The committee and these meetings are a result of the 97-page settlement, reached late last year, of a class-action lawsuit against Aetna over its cutting of physician claims, thereby interfering with recommended treatment to patients.

Still, the physician committee -- three members selected by the plaintiffs, three by the defense and three by the six doctors who had been selected by plaintiffs and defense -- is key to showing Aetna where it went wrong and fostering a better working relationship between physicians and the company.

Many physicians on the committee -- which meets with a group led by Aetna Medical Director William Popik, MD -- are involved with the AMA and their state medical societies, giving organized medicine a strong voice at the table.

Obviously, if Aetna and physicians had a good working relationship already, Aetna might not have been sued. The lawsuit came even though Aetna's chief executive officer, John Rowe, MD, from his first day on the job in 2000 pledged that the company would be more open and more communicative with physicians.

But to many physicians, that promise is still lip service. William Gee, MD, a Lexington, Ky., urologist appointed to the committee by the plaintiffs, said nothing had really changed in his dealings with Aetna, or managed care in general, over the last three years.

For example, one of the committee's tasks is to teach Aetna more about CPT coding, so the company understands why physicians code the way they do and why it's important for Aetna to follow CPT standards instead of committing such sins as bundling and downcoding.

The hope is that Aetna will understand this and help implement changes that will benefit both physicians and patients.

Thanks to the settlement, at least Aetna is planning to tell physicians why their claims have been adjusted and give physicians the opportunity to fight those adjustments.

On Jan. 8, Aetna announced what it calls "enhanced business processes" for physicians, including Aetna's contracting with an independent third party to issue binding arbitration in billing disputes and Web site enhancements to help foster better communication. This is also something that grew out of the 97-page settlement.

In some small way, this represents progress. And while physicians meeting with Aetna on a regular basis might not entirely change Aetna to saint from sinner, at least there's hope that Aetna-physician relations someday can have some kind of revival.

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