AETNA-PRUDENTAL MERGER: TX Docs Fear ‘Onerous’ Contracts
Informal surveys of Houston- and Dallas-area doctors show they are concerned that the pending merger between Aetna Inc. and Prudential Insurance Co. of America's health insurance division will affect more than 20% of their patients, giving the insurer "too much power" and the ability to set "onerous contract terms." "Our concern is that when a doctor's practice is more than 20% with any carrier, it becomes almost impossible to say something is unacceptable," said Dr. Greg Bernica of the Harris County Medical Society. Conducted by medical societies in Dallas and Harris counties, the surveys found about two-thirds of Houston doctors and one-third of Dallas doctors expected their Aetna-Prudential patient pool to reach the 20% saturation point. Aetna spokesperson Joyce Oberdorf did not seem troubled by the 20% mark, saying that having "a large percent of business may create a level of administrative simplicity or add stability to a practice" and that when patient dollars are taken into account, "we'll only have 13% to 15% market share of all physician payments" in Texas. Besides, she said "this survey proves our point. A majority -- 66% -- in Dallas will have fewer than 20% of their patients with Aetna." Still, the Wall Street Journal/Texas Edition reports that doctors in Texas may feel the effects of the merger more acutely because of Aetna's acquisition last year of NYLCare Health Plans Inc., which had a large concentration in Texas. Moreover, some doctors complain that Aetna has been "difficult to deal with" and is "bottom-line oriented." The surveys will be sent to the U.S. Justice Department, which is reviewing the merger, and will be used by the Texas Medical Association "as ammunition" in efforts to pass a bill that would allow doctors to collectively negotiate (Flood, 3/31).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.