AETNA: Disputes with Docs Causing Troubles Nationwide
As Aetna U.S. Healthcare attempts to win support for its proposed $1 billion merger with Prudential Healthcare, the company finds itself beset by disputes with medical providers "because of what they call unreasonable fees, troubling contract provisions and a lack of trust in company management," that have "spread nationwide since a publicized battle last summer between Dallas doctors" and the insurer. Providers have either dropped out of Aetna's network or threatened to do so in Kentucky, West Virginia and Philadelphia, to name a few places. Dr. Ralph Turner of Dallas, who quit Aetna last year, said, "The style of health care that Aetna is trying to practice is just not what some physician organizations want. I am not surprised it's having trouble in other markets." Aetna blames the disputes on its size and its efforts to control costs for consumers. Tim Nolan, who heads Aetna's field operations unit, said, "Everything we do, we position ourselves to be the best. If that means we push a little bit harder, so be it." Some Wall Street analysts praised the company's strategy. "As a publicly traded company, Aetna has to make some decisions -- some painful decisions -- about not only what's best for the patient, but also what's best from a financial standpoint" (Ornstein, Dallas Morning News, 6/1).
USA Today reports that much of the physicians' dissatisfaction centers on Aetna's "all-or-nothing" contracts that require doctors to accept all Aetna patients if it wants to treat any at all. Aetna holds that the contracts make its "product more attractive at an employer level because it gives them flexibility." But according to some doctors, "that's exactly the problem." Dr. Bobby Jacobs of Aurora, CO, recently wrote to American Medical News, "Aetna's all-or-nothing clause is a transparent attempt to force providers to participate in an inferior product so that it may be marketed more effectively to employers." Counters Aetna's Nolan, "If my employer moves from a preferred provider plan to an HMO, why should my relationship with my physician suffer?" (Appleby, 6/1).