Aetna is #1 with Doctors

Even after being the first insurer ever to settle massive class action litigation stemming from accusations of delayed or improper claim handling and reducing reimbursement to doctors, Hartford-based insurer Aetna still lands on its feet. In a national survey of more than 130 large health plans, Aetna ranked #1 because they denied fewer claims and quickly and accurately reimbursed physicians. Cigna, who was first last year, fell to second while New York's Medicaid program scored the lowest among all health insurers.

Even before the 2003 class action settlement, which over a four-year period cost Aetna close to $500 million in cash and operational improvements, Aetna had started outreach efforts to mend its tarnished image with doctors. To further show good faith, Dr. John Rowe, Aetna's former chief executive extended the terms of the settlement to include this year.

Medical societies inside and outside of Connecticut, who once loathed Aetna for its shoddy tactics, seem pleased with its responsiveness and hope its recommitment will serve as a model for other insurers. "It's like night and day" comparing the pre-settlement Aetna with the company of today, said Matthew C. Katz, executive director of the Connecticut State Medical Society. "We may not agree with everything they do, but communications are better than in the past," he added.

Health providers everywhere welcomed Aetna's statement introducing guideline principles for physician relations that included such procedures as: giving 90-day advance notice of any fee changes, allowing 120 days to submit claims, and providing information on its claims policies. They promised to continue working with the Physicians Advocacy Institute, a nationwide nonprofit organization representing physicians', through their own physicians advisory board.

Meanwhile, despite some issues that still need work, Aetna's statement "certainly on the surface seems like a reasonable attempt on their part to continue what was agreed on in the settlement," said Amy E. Cole, director of marketing and communications for the Fairfield County Medical Association.

According to the survey, Aetna took an average of 27 days, compared to several months for some insurers, to pay physicians; they resolved 96 percent of all claims on the first try and denied only 5.9 percent of submitted claims. "We have worked hard to establish a level of trust and respect with health care professionals," said Dr. Troyen Brennan, Aetna's chief medical officer, "and we want to build on that trust and continue to be a high-integrity business partner with the medical community, even when our settlement agreement expires next month."