Confusion keeps some in Aetna plans

The insurer says a small number of doctors have opted out of its all-products contracts. Physicians say the insurer still won't let them.

By Cheryl Jackson, amednews staff. Feb. 25, 2002.

A year after it announced that physicians nationwide would be able to opt out of contracts forcing them to accept all patients, Aetna only says a small number have taken the insurer up on the offer.

But doctors said Aetna made it difficult to exercise that option, with some representatives telling them it applied only to primary care physicians and not communicating the change until after the deadline to opt out had passed. Doctors have to tell Aetna 90 days before their contracts expire that they want out of the all-products clause if they want to sign contracts for PPO products only.

"We have heard there is a attempt by Aetna to maintain the Aetna all-products in a different guise and in a different fashion," said Dr. Ray.

"I would be very suspicious because Aetna has not been truthful with physicians down the line," said Walker Ray, MD, an Atlanta pediatrician and president of the Medical Assn. of Georgia, who left Aetna three years ago over the all-products contracts. "Aetna talks a better game. But they have not substantially changed their way of doing business."

In the first quarter of 2001, 413 physicians-- 203 primary care doctors and 210 specialists -- opted out of the HMO network, said Aetna spokeswoman Wendy Morphew. That represents about one-hundredth of one percent of the physicians who were eligible to opt out, she said. The insurer stopped tracking after the first three months.

"It's minuscule, which we're very pleased about," she said. "Not only did we not see a mass exodus from all-products, but the HMO network grew in the last year 10.6%," she said.

Aetna says its HMO network grew 10.6% last year.

But Texas physician leaders say Aetna has made getting out of the contract difficult by claiming it's hard to differentiate between the PPO and HMO patients. "We think that's a smoke screen," said Louis Goodman, PhD, executive vice president of the Texas Medical Assn.

"There are HMO-type features in a PPO plan. So if you have agreed to participate in a PPO product that has an HMO-type feature, sometimes it's difficult to uncouple those," said Richard Johnson, director of the TMA's division of medical economics. "When a physician says, 'I only want to be in a PPO product line' and the contract is changed to reflect that feature, they can't turn around and say this is very much like an HMO feature. It's kind of a gray area."