Aetna marked the June 2 expiration of its settlement of the federal antiracketeering lawsuit by establishing Guiding Principles for Physician Relations, which it says defines its "continued commitment to building the best possible relationships with the medical community and to working collaboratively to improve the quality of health care."
The principles identify specific behaviors and business actions that govern Aetna in its interactions with physicians. They include allowing physicians to submit claims up to 120 days after treating a patient, making fee schedules available to doctors 90 days before any change, and not using all-product or "gag" clauses in contracts. Aetna also will maintain a Physician Advisory Board of independent practicing physicians who will advise the company on issues important to doctors and make recommendations on Aetna's business practices and policies.
Aetna was the first of the defendants to settle the lawsuit that TMA and several other state medical societies filed against some of the nation's largest for-profit insurers. The lawsuit accused them of using fraudulent marketing tactics and financial incentives to restrict patient care, thereby breaching their obligations under federal law to provide necessary medical care. Settlements involving WellPoint (Anthem), HealthNet, Humana, and all of the Blue Cross and Blue Shield plans are still in effect.
Aetna Chief Medical Officer Troyen Brennan, MD, said the principles "clearly demonstrate, in writing, that we are serious about making it even easier to do business with us and moving forward with the medical community to ensure patients have the highest quality, safest, and most cost-effective care."
Robert W. Seligson, executive vice president and chief executive officer of the North Carolina Medical Society and president of the Physicians Advocacy Institute (PAI), said Aetna "has made significant progress in its relationships with physicians by changing past practices that were not consistently transparent and respectful of providers."
PAI is a nationwide nonprofit organization established in 2006 with money from the settlements of the lawsuits. Its primary mission is to guarantee compliance with the settlements.
Action, June 16, 2008