Strained relations between Aetna U.S. Healthcare and physicians continue, and this time Florida is the hot spot.
Last month, Aetna agreed to revise its HMO contracts after the Florida Department of Insurance warned the Blue Bell, Pa.-based insurer that contract provisions violated state law. Aetna and insurance officials are still negotiating how providers will be notified of the revised contracts.
The department identified the following six provisions as violating state insurance code:
Relations between Aetna and the Florida Medical Association have been strained ever since the insurer issued its new contract last month. Aetna has pacts with 10,000 Florida doctors.
The situation became particularly hostile after the FMA requested a meeting with Aetna to discuss the contracts. Aetna refused, citing antitrust violations, and the FMA asked state insurance officials to investigate.
"Large managed-care companies like Aetna can offer one-sided contracts because they control a large market share of patients," says FMA President Glenn Bryan, M.D. "The physicians' hands are tied, so they cannot advocate on behalf of their patients."
Aetna spokesman Walt Cherniak says Aetna was more than willing to revise the contracts and also points out that a "gag clause" provision the insurance department had taken exception to was removed from the contract last March.
"We have HMOs in 30 states; we sell health insurance in 50 states. Each state has their own set of laws and regulations, and occasionally we need to address some of our contract language to address that," Cherniak says.
Aetna contracts came under similar scrutiny from the Texas Department of Insurance last year. Texas Medical Association counsel Rocky Wilcox characterized Aetna's contracts as even more "far-reaching" than other "one-sided" HMO contracts. The state passed sweeping managed-care reform legislation in 1997, and Aetna revised its contracts soon after.
"The HMOs have such market power that they can, generally speaking, dictate the terms and conditions of the contracts," Wilcox says. "The only way you're left to deal with abusive provisions is to get a law or regulation on the books. So that's the game we're in."