Aetna Hammers Out Class-Action Settlement With Doctors

By

Aetna Inc., Hartford, has negotiated a settlement with lawyers representing 700,000 U.S. doctors in a dispute over handling of managed care claims.

The agreement, which is subject to court approval, calls for Aetna to pay $100 million to the doctors, or about $140 per doctor.

The agreement also calls for Aetna to pay $50 million in legal fees, contribute $20 million to a health quality foundation, give doctors more information about how it pays bills and set up an independent billing appeals process.

Aetna negotiated the agreement to resolve its share of the managed care lawsuits now being heard in Miami.

Lawyers began organizing suits against Aetna and other managed care companies in 1999. Lawyers for the doctors have accused carriers of conspiring to delay payments and deny valid claims.

A panel of federal judges transferred many of the cases to the U.S. District Court in Miami in October 2000. U.S. District Judge Federico Moreno declined in September 2002 to certify a class of plan members, but he did certify a class of doctors.

Dr. Donald Palmisano, president-elect of the American Medical Association, Chicago, suggests that the proposed Aetna settlement could serve as a model for other carriers. The association “expects this settlement to raise the bar for the entire health insurance industry on fair and open business practices,” he says.

Dr. Jack Rowe, Aetnas chairman, says the settlement should help Aetna improve cost management by improving relations with doctors.

Paul Rooney, president of Employee Benefit Solutions, Newton, Mass., a benefits consulting firm, says an amicable resolution to the Miami litigation would help the entire health insurance market by strengthening the patient-doctor relationship.

If doctors and insurers fail to come together, “then politicians in Washington will be providing answers that neither side wants,” Rooney warns.


Reproduced from National Underwriter Life & Health/Financial Services Edition, May 26, 2003. Copyright 2003 by The National Underwriter Company in the serial publication. All rights reserved. Copyright in this article as an independent work may be held by the author.