AETNA: M.D. Contracts Spark Fla. Regulators’ Concerns
Florida insurance regulators last week gave Aetna U.S. Healthcare Inc. "until the end of July to eliminate apparent conflicts with state law in its contract with doctors," the St. Petersburg Times reports. One area of concern involves coverage of emergency services. While Aetna says it "should have final authority to decide whether emergency services are covered," Florida law "says only doctors or licensed hospital personnel can decide if an emergency condition exists." Another area involves a contract clause stating that Aetna "has the right to inspect a patient's medical records without a special written release." The Times notes that Florida law "maintains that patients' records belong to the doctor, who can release the information only with patient consent." Regulators also questioned a clause that may have violated a ban on so- called gag clauses in physician contracts. However, an Aetna official insisted that no gag clauses are in its physician contracts and that "the provision they're referencing was deleted to avoid any such conclusion." A spokesperson for the Florida insurance department said the letter sent to Aetna last week outlining regulators' concerns "did not have the force of a ruling."
Aetna spokesperson Walter Cherniak defended the company's contracts and said Aetna plans to address the issues directly with regulators "and make any adjustments if necessary." However, the Florida Medical Association, which requested the state review of Aetna's contracts, "hailed the department's actions as a victory for patients." FMA President Dr. Glenn Bryan said, "The contract was clearly in violation of Florida law, and its intent was to compromise the quality of care patients receive. This is another example of the restrictive care environment physicians encounter daily." Cherniak countered the FMA arguments, saying, "We think the FMA is grossly mischaracterizing the matter. It's engaged in a direct campaign to misinform patients about our contract provisions." Aetna contracts with 10,000 Florida physicians and has 187,000 HMO members in the state (Hundley, 7/25).