Aetna settlement nearing final stages of completion

The plan's chief medical officer looks forward to physician-health plan interaction in the post-settlement era.

By Tanya Albert, amednews staff. Nov. 3, 2003. SEE UPDATE

Not long after a federal judge in Miami knows how the Florida Marlins fared in the World Series, physicians should know whether they have final approval on their settlement with Aetna over its business practices.

At an Oct. 14 final hearing on the $170 million deal between the nation's physicians and one of the nation's largest health insurers, U.S. District Court Judge Federico Moreno delayed his final decision. He jokingly said the ruling likely would come after the World Series, especially if his home-team Florida Marlins made the series. At the time, they were battling the Chicago Cubs for the National League Championship. Moreno said he would take the time to review a number of objections filed before the hearing, including a concern that physicians don't know the exact value of the case.

CIGNA settlement front
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The judge already has given the agreement preliminary approval, and lawyers involved in the settlement expect that he will give his final stamp of approval after he reviews the objections. A ruling could come by Oct. 27.

"I'm optimistic that Judge Moreno will approve the settlement and it will move on," said Birmingham, Ala., attorney Archie Lamb Jr., co-lead counsel for the physicians. "We rebutted every single point."

In addition, only 13,000 physicians opted out of the class. That is less than 2% of the class if it is 700,000 physicians, as originally believed. The opt-outs become less than that if the class is the 950,000 doctors that some now estimate it will be when retired physicians are factored in.

The settlement is the result of class-action litigation filed by individual physicians and medical societies against Aetna claiming the insurer arbitrarily reduced payments and interfered with physicians' decisions about what were the best treatments for patients. Doctors and organized medicine filed similar lawsuits in several states against other large health plans that were ultimately sent to Moreno's court for pretrial hearings.

Aetna in May became the first company to settle with physicians who had lawsuits in Moreno's court, agreeing, among other things, to simplify the claims process, pay claims faster and adopt a clear definition of "medical necessity." CIGNA HealthCare became the second company to reach a settlement to receive preliminary approval from Moreno. A final hearing on that settlement is scheduled for December.

Under the Aetna settlement, doctors will receive an average of $142 per physician. But most doctors opted to give their money to a foundation created under the settlement. That money will be used to form and support a national advisory committee that will advise Aetna on issues physicians think are important.

New era

Aetna Chief Medical officer William C. Popik, MD, said he sees the settlement as a very visible sign to physicians that the company is ready to move forward and try to better meet their needs and concerns.

"The new Aetna knows that we have much more in common with physicians than not," Dr. Popik, who was a family physician in California before moving into health care executive roles, said in an interview in Chicago. "The things physicians were asking for were the right thing to do."

In addition to the foundation, he believes several things spelled out in the agreement will help improve relations between the average physician and the health plan. Many of the changes fall under the area of communication, including:

Using Aetna's Web site to file claims and track their progress toward being paid.
Looking up CPT codes on the Web site and seeing how that code would be adjudicated.
Posting fee schedules on a physician Web site.
Creating service centers that will only take calls from physicians.
Establishing a pharmacy discount card program that doctors can offer to their patients.

Twenty-seven state and county medical societies have signed on to the settlement.

Dr. Popik said he sees a court-enforceable document as a good way to start a new era between the health plan and physicians. "The settlement ... is a visible line in the sand," he said. "It is a way to comfort people who had not had reason to trust us."

ADDITIONAL INFORMATION:

CIGNA settlement front

While physicians have missed their opportunity to choose whether to opt out of the Aetna settlement, here's what you need to know about the CIGNA HealthCare settlement.

Initial class notice: Mailed to physicians Oct. 6.

Opt-out deadline: Nov. 20. A physician who does not want to be part of the class settlement must send a signed statement to that effect that includes his or her name, business address, telephone number and Federal Tax Identification Number to: CIGNA Physicians Settlement; Settlement Administrator; PO Box 3170; Portland, OR 97208-3170

To participate in the settlement: Physicians do not need to do anything at this time. Information about claims for compensation will be distributed after a final fairness hearing scheduled for Dec. 18.

Further questions?
Consult these Web sites:
   www.cignaphysiciansettlement.com
   www.archielamb.com
Call this phone number:
   877-683-9363