Aetna vows to continue settlement terms

Aetna executives are promising not to abandon the changes the insurer made over the past five years as conditions of a class-action lawsuit settlement in a case involving several health plans. Organized medicine is saying it will watch the company closely to make sure that promise is kept.

On May 28, Aetna issued a list of commitments it said it would make as of June 2, when its five-year settlement with physicians and multiple medical societies expired. Aetna was one of numerous plans that settled lawsuits accusing them of developing schemes to underpay doctors, though the plans did not admit wrongdoing.

Aetna specifically committed to continue: allowing doctors to leave the network 90 days after giving notice; allowing claims submissions up to 120 days after the date of care; making its fee schedule available 90 days before any change; and contracting without all-products or gag clauses.

Aetna also promised to maintain its Physician Advisory Board, which advises the insurer on coding and reimbursement issues.

"I think it's pretty clear that most of this stuff is just good business practice," said Troyen Brennan, MD, MPH, Aetna's chief medical officer. "We've gotten beyond unhelpful adversarial relationships," he said. "We have every intention of maintaining those warm and collegial relationships."

North Carolina Medical Society Executive Vice President and CEO Robert W. Seligson is also president of the Physicians Advocacy Institute, which has overseen compliance with Aetna's settlement and others between health plans and doctors. He called Aetna's commitment to future cooperation with physicians a "model for other health plans."

"We obviously will not always agree," Seligson said in a statement. "However, Aetna's commitment to remain true to the spirit of the settlement agreement ensures our conversations will be candid and productive, and this will set the stage for quicker resolution of any future issues."

Other health plan settlements will expire in a few years, and Cigna's already has expired. Cigna committed to some, but not all, of what was required under the settlement. For example, it no longer is committed to prohibiting all-products clauses

Matthew Katz, executive director of the Connecticut State Medical Society, one of the original signatory societies in the Aetna settlement, said doctors have complained during the settlement period about Aetna's payments to out-of-network physicians, its tiered network program and its practices in its workers compensation business.

"We are pleasantly surprised that Aetna would voluntarily commit to making the changes the settlement required moving forward, because the concern we had was that the health plans would not continue on with these business practices," he said. "We are cautiously optimistic."

Aetna has come a long way in terms of its dealings with doctors since 2003, when the settlement was reached, Katz said.

"In the past, they were the least liked," he said. "Today they are definitely high up there from a health plan perspective."

Meanwhile, the Physicians Foundation for Health Systems Excellence, established by the initial $20 million from the settlement, will continue to award grants aimed at helping physicians improve their care and practices, Aetna spokeswoman Karin Rush-Monroe said.