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, AMNews staff. July 7, 2008.

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.