Aetna Re-Commits to Better Physician Relationships

Nearly five years ago, Aetna committed to working more closely with physicians following a class-action lawsuit settlement with multiple state medical societies. Aetna was one of many health plans accused of concosting schemes to underpay doctors.

Terms of the settlement included:

• Funding of a physician grant-making organization later called the Physicians Foundation for Health System Excellence.
• Forming a Physician Advisor Board to advise Aetna on coding and reimbursement issues.
• The creation of the Physicians Advocacy Institute to oversee compliance on coding and reimbursement issues.

Aetna also committed to:

• Allowing doctors to leave the network 90 days after giving notice.
• Allowing claims submission up to 120 days after the date of CAE.
• Making the fee schedule available. 90 days before any change
• Contracting without all-products or gag clauses.

What Aetna has done is to re-commit to these various changes on June 2, when its 5-year settlement with Aetna and other health plans will expire.

What is the lesson here? It is that confrontation between physicians and health plans can lead collaboration. In the case of Aetna, according to a survey conducted by Athenahealth, a claim processing firm, Aetna has moved to the top of the list as the health plan in paying claims accurately and quickly. The top eight firms, in order of ranking, are:

1. Aetna
2. Cigna
3. Humana
4. Medicare (Part B)
5. UnitedHealth Group
6. WellPoint
7. Coventry Health Care
8. Champus/Tricare

Meanwhile, the Physicians Foundation for Health System Excellence has been offering grants worth millions of dollars to physician organizations to help them improve the efficiency and quality of care. The Foundation is also conducting a survey of the nation’s primary care physicians and certain specialties to assess their socioeconomic and attitudinal status.