Aetna and Ohio doctor group settle payment lawsuit

Physicians in Greater Cincinnati likely will see an increase in the amount Aetna pays them for seeing patients, thanks to an agreement between the insurer and the Academy of Medicine of Cincinnati and other plaintiffs.

Local physician payments will increase by $22.3 million over three years, under a proposed settlement that Aetna and doctors in Cincinnati and Northern Kentucky announced in December 2004.

The proposed agreement, which still needs final approval from the courts, resolves a lawsuit that challenged the way Aetna reimbursed physicians.

"Going forward, it establishes new levels of expectations for physicians," said Russell Dean, executive director of the Academy of Medicine of Cincinnati. "Doctors will still have to fight or negotiate [contracts] ... but we know the pot is bigger."

In addition to resolving a highly contested dispute between physicians and Aetna, Allan Greenberg, president of Aetna's North Central region, said the settlement would foster better cooperation between Aetna and Greater Cincinnati doctors.

"It ... continues an effort Aetna began several years ago to work more collaboratively with physicians and to improve the health care delivery system in ways that make it easier for physicians and insurers to work together with great trust," Greenberg said in a statement.

The settlement also proposes that a compliance committee be established in 2007 to review reimbursement negotiations between doctors and Aetna to ensure that the rates are competitive. That committee would run through 2009.

In 2003, Greater Cincinnati physicians struck a similar settlement with Humana. Lawsuits they filed against Anthem and UnitedHealthcare in state courts are still proceeding.

Neither Aetna nor Humana admitted wrongdoing as part of the settlements.