AETNA U.S. HEALTHCARE: Faces Renewed AMA Criticism
The American Medical Association is charging that Aetna U.S. Healthcare Inc.'s physician contracts undermine the doctor-patient relationship and block "certain types of treatment," the Akron Beacon Journal reports. In a February 24 letter to Aetna President and CEO Richard Huber, AMA Board Chair Dr. Thomas Reardon wrote that the managed care company's "definition of medical necessity is extremely narrow, focuses minimally on clinical medicine and instead is premised on cost and convenience to the plan." An AMA spokesperson said the letter was prompted by "complaints from doctors in several states, including Ohio." This marks the first time the AMA "has publicly broadsided an insurer" (Sandstrom, 3/4).
A Long List
The AMA letter raises several specific categories of concerns about Aetna US Healthcare's physician contracts. First, the AMA contends the HMO prevents physicians from making medical decisions for patients by retaining the authority to decide which services are medically necessary. The contracts provide no process whereby a physician can appeal treatment denials. Further, the letter objects to Aetna U.S. Healthcare's contractual "gag clauses" that can be used to automatically terminate physicians who inform their patients about treatment options not covered by the plan. And finally, the letter complains that the HMO violates physician-patient confidentiality by securing co-ownership of medical records and requiring patients to sign a release form so broad as to give the plan "unfettered access to highly personal patient information." According to AMA trustee Dr. Ted Lewers, this is the second letter written to Aetna U.S. Healthcare in four months The plan's response to the first letter "led us to believe they did not understand the points we were making" (AMA release, 3/3). According to the Akron Beacon Journal, Aetna/U.S. Healthcare has "denied the AMA's charges, and noted that Congress' General Accounting Office reviewed its contracts and found no gag clauses. The contracts with doctors comply with national standards, it said" (3/4).