Aetna

The Aetna Settlement

In May of 2003, Aetna U.S. HealthCare agreed to settle a series of lawsuits by executing a Settlement Agreement with 18 medical societies, physician plaintiffs and their attorneys.

Highlights of the agreement included:

• $100 million Settlement Fund for Physicians
• $20 million Foundation
• $310 million estimated costs of "prospective relief"--the costs to Aetna to make business changes required by the Settlement Agreement
• Reform of Aetna's business practices affecting physician practices
• Disclosure and transparency in claims payment and medical review decisions
• Streamlined compliance and appeals processes for resolving disputes
• Formation of a National Advisory Committee of Practicing Physicians, a Billing Dispute External Review Board and Medical Necessity External Review Process
• To fulfill the last requirement, an Aetna Physicians Advisory Committee was formed. View the List of Aetna PAC members.

Critical to the success of this settlement is the enforcement process, which will be led by Cameron Staples, Esq., Partner with Neubert, Pepe & Monteith, P.C. In his role as the Compliance Dispute Facilitator, Mr. Staples will oversee the compliance dispute resolution mechanism which is designed to address physician complaints regarding Aetna's compliance with the terms of the settlement agreement.

The compliance dispute process is triggered by filing a brief dispute form describing how Aetna has violated the terms of the settlement agreement. Documentation which illustrates the violation should be included with the form. Filing a compliance dispute involves no cost to physicians or their practices, since Aetna is required to pay the full cost of the enforcement process. For further information about the compliance dispute process or a copy of the dispute form, just click on the appropriate links below.

Links:

• Aetna Step-by-Step Compliance Dispute Procedure
• Aetna Compliance Dispute Form
• Aetna Additional Signatory Medical Society Joinder Form