Aetna: Step by Step Compliance

Listed below are the steps for a physician to take if he or she believes that Aetna has violated the terms of the Settlement Agreement.

1. Any physician who has not opted out of the settlement or any signatory medical society who has been asked by the physician to pursue the matter, may file a compliance dispute to the Compliance Dispute Facilitator (the "Facilitator"), Cameron C. Staples.
2. Access to the form online: compliance dispute form (PDF). Access to the form via phone: call the Facilitator (1-203-821-2000).
3. The form must be completed by the physician or his office staff, and the form must include the physician's signature. The physician should describe using specific facts, the health plan's conduct which he or she believes constitutes a material breach of the health plan's obligation under Section 7 of the Agreement. The physician should specify when provision of Section 7 has been breached, and describe how he or she has been harmed by the breach.
4. The physician should attach to the form any supporting documentation, including any correspondence between the physician and the health plan, and any records which the physician believes are relevant for the Facilitator to determine the merits of the complaint.
5. The completed form and attachments should be mailed to the Compliance Dispute Facilitator at the address below. No fee is required.
6. After the Facilitator receives the compliance dispute form, the Facilitator will contact the physician to advise whether the form is properly completed, and the Facilitator will advise the physician on whether in the Facilitator's opinion, the alleged wrongful conduct is a compliance dispute.
7. The Facilitator will prosecute the dispute on the physician's behalf without charge, and keep the physician informed as the compliance dispute process takes its course.
8. The address for the Facilitator is: 
   
   Cameron C. Staples
   195 Church Street
   13th Floor
   New Haven, CT 06510-2009
   Phone: (203) 821-2000
   Fax: (203) 821-2009
   Email: CStaples@npmlaw.com