Dentists and Aetna Reach Agreement to Improve Efficiency and Enhance Communication
Faster reimbursement, reduced administrative complexity, funding of foundation to promote better dental health highlight agreement; upon court acceptance, agreement would conclude litigation
Chicago and Hartford, Conn., August 19, 2003 — Representatives of 147,000 dentists, the American Dental Association and Aetna (NYSE: ΑET) have reached agreement seeking to improve communication and collaboration, and lessen complexity in the payment of dental claims. Dentists and Aetna anticipate that these initiatives will enable them to operate more efficiently, and serve patients and customers more effectively.
If approved by the court, the agreement would settle a national dental class action that had been consolidated with a series of similar actions brought on behalf of physicians. The agreement follows a proposed settlement of the physician cases announced on May 22 and given preliminary approval by the court on June 2.
The actions embodied in the agreement are expected to result in increased predictability and speed of claims payment for dentists; creating significant value by reducing time-consuming and costly administrative burdens, and giving dentists and their office staffs more time to focus on their central mission – providing care to patients. Aetna also expects that these actions will allow it to operate more efficiently and serve its customers and members more effectively, with lower administrative costs over time.
Aetna has agreed to pay $4 million to dentists and $1 million to the ADA Foundation. The costs associated with this agreement were anticipated and already recorded in the second quarter of 2003 as part of the charge associated with Aetna’s settlement of the Physician Class Action Litigation.
"This agreement marks another important step in Aetna’s efforts to lead the industry in building a more efficient health care system and strengthening our working relationship with the health care community," said John W. Rowe, M.D., chairman and CEO of Aetna. "Our expectation is that by introducing specific business-practice initiatives and new levels of transparency in our relations with dentists, we will achieve a common goal of better dental health for our patients."
"This is a significant agreement for dentists," said T. Howard Jones, D.M.D., president of the American Dental Association. "Our primary concern always has been and always will be patient care. The reimbursement process and how quickly and accurately we are compensated should not interfere with patient care, and our member dentists are pleased that many of their issues were addressed fairly. We believe this new level of cooperation and transparency will benefit patients and become a model for the industry."
Openness and Cooperation
Key elements of the agreement include:
Establishing a Dental Advisory Committee to provide advice to Aetna on issues of concern to dentists.
A commitment to timely processing of "clean" claims.
Initiatives to reduce claims resubmissions.
Disclosure of claims-editing policies, procedures and practices.
Increased electronic connectivity, and direct web-enabled access to Aetna systems to verify reimbursement information and track claims.
Contribution to Foundation to Promote Dental Health
Under the agreement, Aetna will contribute $1 million to the ADA Foundation in order to support the foundation’s initiatives to enhance dental health care for Americans. Among the projects currently supported by the foundation are:
Promoting dental health education among traditionally underserved populations, including addressing racial, economic and geographic disparities; this initiative complements Aetna’s comprehensive initiative to reduce the risks associated with racial and ethnic disparities in health care announced by Aetna on March 5, 2003;
Promoting children’s dental health, including fluoridation and education;
Promoting evidence-based dentistry, including research into and dissemination of information regarding pharmacology, dental disease and standards of care;
Supporting research that fosters greater understanding of the relationship between dental disease and systemic disease.
The not-for-profit ADA is the nation’s largest dental association, representing more than 147,000 members. The premier source of oral health information, the ADA has advocated for the public’s health, and promoted the art and science of dentistry since 1850. The ADA’s state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer and professional products. For more information about the ADA, visit the Association’s web site at www.ada.org.
The ADA Foundation is the charitable arm of the American Dental Association, and is dedicated to improving health and making lives better, one person at a time. Since 1991, the ADA Foundation has disbursed more than $11 million to support such charitable activities.
Aetna is one of the nation’s leading providers of health care, dental, pharmacy, group life, disability and long-term care products, serving approximately 13.0 million medical members, 11.3 million dental members and 11.7 million group insurance customers, as of June 30, 2003. The company has expansive nationwide networks of more than 579,000 health care services providers, including over 349,000 primary care and specialist physicians and 3,589 hospitals. For more information about Aetna, please visit the company’s web site at www.aetna.com.