The Principles coincide with the June 2, 2008 expiration of the Physicians Settlement Agreement with Aetna and are relevant at a time when concerns about health care access, quality and affordability are top of mind for most Americans.

"True health care reform will come from public, private and government sectors addressing issues together. We have worked hard to establish a level of trust and respect with health care professionals. And we want to build on that trust and continue to be a high-integrity business partner with the medical community, even when our settlement agreement expires next month," said Troyen Brennan, M.D., Aetna’s chief medical officer. "These Guiding Principles clearly demonstrate, in writing, that we are serious about making it even easier to do business with us and moving forward with the medical community to ensure patients have the highest quality, safest and most cost-effective care."

"Aetna has made significant progress in its relationships with physicians by changing past practices that were not consistently transparent and respectful of providers," said Robert W. Seligson, executive vice president and CEO of the North Carolina Medical Society, and president of the Physicians Advocacy Institute (PAI), a nationwide not-for-profit organization that advances the interests of the physician community. "Much of that success has resulted from the company’s constructive dialogue with physicians and putting its words into action. We obviously will not always agree. However, Aetna’s commitment to remain true to the spirit of the settlement agreement ensures our conversations will be candid and productive and this will set the stage for quicker resolution of any future issues. Aetna’s voluntary continuation of the business practices from the settlement is a model for other health plans."

Creating guiding principles reflects Aetna’s historically proactive approach to working cooperatively with the medical community. Aetna was the first health plan to settle the class action lawsuit with physicians and voluntarily extended its settlement agreement one year past the original end date. The company also transferred funds ahead of schedule to the Physicians Foundation for Health Systems Excellence, created as a result of the physicians’ settlement, to expedite the Foundation’s mission to improve health care quality. In addition, the company was the first health plan to make its clinical policy bulletins available online.

All of the changes Aetna made as part of the settlement agreement are embedded in the company’s business model and are consistent with the way the company wants to continue working with physicians. The Principles reinforce those changes and include commitments such as:

Aetna will work to make it easier for physicians to do business with us.

• We will allow physicians to terminate from our network 90 days after we receive their notice, with no need to show cause.
• We will continue to allow submission of claims up to 120 days following provision of service.

Aetna will continue to make our business processes as transparent as possible.

• We will continue to make fee schedules available for participating providers 90 days prior to the effective date of any change.
• We will provide transparent information on our claim check logic and continue to work with providers to ensure consistency in bundling and other claim policies.
• We will continue to disclose all precertification requirements on a timely basis.
• We will not use all-product or "gag" clauses in contracts, but will continue to use the new definition of "Medical Necessity."

Aetna also has committed to strengthening a variety of forums through which the company can have important ongoing dialogue with the medical community. As examples:

• The company will continue working with the PAI to help physicians better understand how various health plan initiatives, like pay for performance and physician ratings, impact the day-to-day care that physicians provide their patients. Aetna is discussing with the PAI the voluntary establishment of new mechanisms to address physician questions about company policies.
• Aetna also will maintain the Physician Advisory Board, a distinguished group of independent practicing physicians who provide advice on issues of importance to doctors and make recommendations as appropriate with regard to Aetna’s business practices and policies.

Since the Settlement Agreement, Aetna has simplified business transactions with physicians, increased transparency of policies and processes, and worked with the medical community to encourage adherence to evidence-based guidelines in medicine, among other improvements. Business practice changes that support the exchange of more timely, consistent and transparent information have had the greatest impact on the company’s relationships with doctors.

Aetna also has created a similar set of guiding principles for working with the dental community. Aetna’s settlement agreement with dentists ended in April.

To see the Principles, please visit Guiding Principles for Physician Relations and Guiding Principles for Dentist Relations.

About Aetna
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 37.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. www.aetna.com.