Aetna requires doctors to opt out of workers' compensation network

Some in organized medicine see this policy as going against the company's promise to honor the terms of a lawsuit settlement.

By Emily Berry — Posted July 7, 2008

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Even as Aetna executives pledged in June to continue to abide by the principles of its expiring class action settlement with physicians, the company clashed with doctors in several states over what some see as a sleight of hand with its workers' compensation business.

Several state medical societies have alerted doctors that they must opt out of the Aetna Workers' Compensation Access network if they don't want to be paid under workers' compensation insurance fee schedules. Those fee schedules often pay less than PPO or HMO plans.

Aetna has sent opt-out letters to Connecticut doctors over the past year, and the Connecticut State Medical Society is looking for answers, Executive Director Matt Katz said.

"It is a bit disingenuous for Aetna to say they're providing transparency [in contracting] if in this case doctors don't know in advance they're part of the network," he said.

Aetna, meanwhile, claims that adding doctors to its workers' compensation network with an opt-out process, rather than an opt-in, simplifies the process for physicians.

"The opt-out process is easier than requiring physicians to contact Aetna and complete the process to become part of the network because it involves fewer administrative steps and is faster," spokeswoman Katie Vukas wrote in an e-mailed statement.

She said letters have gone to doctors around the country who are part of its other networks, as Aetna has expanded its workers' compensation network state by state. Recipients generally have 30 days to opt out, she said.

Vukas said this approach does not violate Aetna's professed principles. The company also said the opt-out process is not equivalent to an all-products clause, which requires physicians to sign up for all of an insurer's plans if they want to sign up for one.

But Carol Scheele, general counsel at the North Carolina Medical Society, said that despite overall improvements in its work with doctors, in this case Aetna is failing to live up to its promise to deal with them fairly. "They kind of shove people into it, and they do it in a hard-to-see way -- all of a sudden they're participating."

Scheele said Aetna's opt-out letters have come out a few times over the last three or four years as network rules changed, and each time her society alerts physicians to read the letters carefully and opt out if they wish.

Other workers' compensation insurance companies pay Aetna for access to its physicians and accompanying network. Last year Coventry Health Care reached an agreement with Aetna to share a network, essentially creating one large national workers' compensation network.

"The doctors are ultimately being paid by a different entity that they don't even recognize," said the Connecticut society's Katz. "Many didn't even know they were part of the network." He said his organization has requested to meet with Aetna staff over the issue.

"If Aetna is committed to transparency and its guiding principles, that should be in all of their plans, not just commercial."

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