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Your voice is not being heard about the Patients' Bill of Rights
In 1985, Aetna, one of the nation's strongest insurance companies selected Dr. Markus for the Aetna Prevent problem.  Twelve months later, they were over $20,000 delinquent in their payments.  They set up a meeting.  Four Aetna executives were helicoptered to Philadelphia where they were picked up in a limousine and taken to the office.  They eventually paid the money owed.  They certainly could have saved money somewhere on this story.  Several years ago, they merged with USHealthcare.  That was the end of any semblance of sanity.

February 25, 2001
Somewhat of an interesting article in today's Washington Post Business 
section on Aetna's difficulties with medical HMOS: 

While it is primarily a medical article, I tend to believe that insurance 
companies tend to model dentistry after medical, and the article deals with a 
suit filed by medical societies "against the Hartford insurer and five other 

HMOs, alleging a long pattern of unfair and deceptive practices." It's a 
rather long article, but there are implications for dental 
practices--including the results of how their customer service reps handled 
complaints and the coercion placed on MD's that at times reminds me of Delta 
and BC/BS. For those who don't want to read the entire article, I'm 
including my "Reader's Digest" version--which as we all know from previous 
Reader's Digest articles on health care, can be quite slanted in perspective. 

Among other quotes in the article: "Stuart F. Seides, a cardiologist 
who is president of the 2,400-member Medical Society of the District of 
Columbia, called Aetna the most tightfisted of the major HMOs: It pays $80, 
for example, for a comprehensive cardiac consultation; less than half what 
Medicare pays. "Mother Aetna is the ugliest of the ugly sisters in the HMO 
business," he said." 

"In recent interviews in Aetna's sprawling, gold-domed headquarters, 
Donaldson and Rowe talked about moving swiftly to undo their predecessors' 
mistakes....Recruited to Hartford with multimillion-dollar salary, stock and 
bonus packages, the two men pledged to build a dynamic industry leader that 
will be more responsive to the 290,000 doctors and 3,100 hospitals that serve 
its members ; about half of whom are in the company's HMOs."It's intolerable, 
really, for all the elements in the health-care business to sort of be at war 
with each other," Donaldson said in one of the company's eighth-floor 
executive suites, a world of vintage Persian rugs; finely woven Bidjars and 
Sarouks; and hand-carved antique mahogany furniture: a Chippendale-style 
bookcase here, a Hepplewhite-style serving table there." 

"But in separate interviews Donaldson and Rowe also served notice that 
the new Aetna is still first and foremost a business, unwilling to yield to 
what it views as unreasonable; and costly; demands of doctors and 
customers.Donaldson, 69, did not disguise his annoyance with doctors who have 
painted Aetna as the villain of the managed-care industry."We're trying to 
bring some discipline to, let's say, doctors . . . who send out for 25 tests 
or who do things that are unnecessary," he said. "The medical profession has 
been taught in school that everything is okay. I mean: 'Send out for 1,000 
tests. Do it.' You know, with no attention to price control. No attention to 
the efficient and effective practice of medicine. I think that's changing 
now. And it has to change." 

"And HMOs also have been criticized unfairly for delaying payment of 
claims, Donaldson said. "If claims are not paid on time, there are a lot of 
reasons," he said. "I'm sure if you're alive, as we are, you fill out as many 
insurance forms as I do when you go to the doctor's office. There's so much 
scope for mistake. I mean, if you put a wrong middle initial on a claim, it 
comes to us; millions a day; and we bounce it back and the person who doesn't 
get paid complains to their congressman." 

"From Washington to Los Angeles, doctors have complained loudly about 
the take-it-or-leave-it rules Aetna has instituted. For example, they have 
been required to call the company for permission to perform many medical 
procedures.And if they wanted to participate in Aetna's higher-paying health 
plans, such as PPOs, they had to treat patients covered by the company's 
lower-paying HMOs." 

"The lawsuit claims that Aetna has denied reimbursement to physicians 
for medically necessary services, that it has allowed "individuals lacking 
the necessary medical training to make such determinations" and that it has 
given bonuses to claims administrators "based upon claims savings for denying 
healthcare services."An Aetna spokesman declined to comment on the lawsuit." 

"Donaldson, for example, has instructed customer-service 
representatives to deal more effectively with complaints from patients. 
Previously, he said, Aetna would focus on how quickly each phone call had to 
be answered; say, in five seconds; rather than getting the complaint 
resolved. "That doesn't do much good if the person goes away and you haven't 
helped their problem," Donaldson said." 

For the unabridged version, cut and paste this to your browser: http://washingtonpost.com/wp-dyn/articles/A48155-2001Feb23.html