LEGAL RESOURCES
Aetna’s New Contract Addendum
Important Information Related to Aetna Physician Contracts:
New Contract Addendum Sent to Physicians Nationwide
November 18, 2005
Between November 21 and December 31, 2005 physicians nationwide received an “Addendum” to their current physician contracts. This Addendum is a result of an historic settlement agreement between Aetna, Inc. and nearly 30 medical societies. Under the terms of the settlement agreement dated May 21, 2003 Aetna promised to make numerous changes to its business practices, many of which are reflected in physician contract provisions. In return, the pending national class action lawsuit and multiple state court actions were dismissed.
The Addendum outlines, reinforces and clarifies selected provisions within the 2003 Physician Settlement Agreement. Aetna has indicated that since the settlement agreement took affect, it has operated as though all settlement agreement promises are incorporated in the physician’s contract. In the cover letter to the Addendum, Charles Cutler MD, Aetna Chief Medical Officer, states that “Aetna is committed to the principles of open communication, active listening and respectful conversation with the physician community.” He also emphasizes that physicians with ideas for improvement are encouraged to share them with Physician Advisory Board, the nine-person panel established under the settlement agreement. In compliance with the settlement, this physician board provides practicing physicians input into Aetna policy decisions.
The Addendum is a result of a settlement compliance dispute proceeding. In essence, several physicians filed disputes under the settlement agreement “compliance dispute process” alleging that Aetna’s standard contracts did not comply with the settlement agreement. After months of negotiations, the parties agreed on the Addendum.
The Addendum supersedes the main body of Aetna’s standard physician agreement in those instances where the provisions are inconsistent. Better state law or superior language in individually negotiated provisions of a contract will also prevail. Examples of provisions in the Addendum are: definitions of “clean claim” and “medically necessary services”, provisions covering gag clauses and all products clauses, a complete list of Aetna obligations under the settlement and restatements of coding and other payment provisions. The Addendum also extends the settlement agreement for an additional one-year period (until June 2, 2008) for most provisions of the Addendum.
For further information about the Addendum, please contact your local Aetna network representative, or submit a query to [email protected].
The Physician Advisory Board can be reached at www.aetna.com (Select “Doctors and Hospitals,” then “Physician Advisory Board.”)
For more information about the lawsuits and the compliance process, including a new “Settlement Enforcement Toolkit” please go to www.hmosettlements.com (click on “Compliance” on the left of the screen) or call MSSNY.
