Aetna vows to continue settlement terms

The plan releases a list of commitments it is making to physicians.

By Emily Berry, AMNews staff. June 16, 2008.

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."