By Dec 31, physicians nationwide should have received an "Addendum" to their current physician contracts with Aetna. This Addendum is a result of an historic settlement agreement between Aetna, Inc., and nearly 30 medical societies. Under terms of the settlement agreement dated May 21, 2003, Aetna promised to make changes to its business practices, many of which are reflected in physician contract provisions. In return, the pending national class action lawsuit and multiple state court actions were dismissed.

The Addendum outlines, reinforces, and clarifies selected provisions in the 2003 Physician Settlement Agreement. Aetna has indicated that since the settlement agreement took effect, it has operated as though all settlement agreement promises are incorporated in the physician's contract. In the cover letter to the Addendum, Charles Cutler, MD, Aetna chief medical officer, states that "Aetna is committed to the principles of open communication, active listening, and respectful conversation with the physician community." He encourages physicians with ideas for improvement to share them with the Physician Advisory Board, a nine-physician panel established under the settlement agreement.

The Addendum is a result of a settlement compliance dispute proceeding. In essence, several physicians filed disputes under the settlement agreement "compliance dispute process," alleging that Aetna's standard contracts did not comply with the settlement agreement. After months of negotiations, the parties agreed on the Addendum.

The Addendum supersedes the main body of Aetna's standard physician agreement in instances where the provisions are inconsistent. Better state law or superior language in individually negotiated provisions of a contract also will prevail. Examples of provisions in the Addendum are definitions of "clean claim" and "medically necessary services," provisions covering gag clauses and all products clauses, a complete list of Aetna obligations under the settlement and restatements of coding and other payment provisions. The Addendum also extends the settlement agreement for an additional one-year period (until June 2, 2008) for most provisions.

For further information about the Addendum, physicians can contact their local Aetna network representative or submit a query to AddendumInquiry@Aetna.com. The Physician Advisory Board can be reached at www.aetna.com (Select "Doctors and Hospitals," then "Physician Advisory Board"). For more information about the lawsuits and the compliance process, including a "Settlement Enforcement Toolkit," go to www.hmosettlements.com (click on "Compliance" on the left of the screen). You also may visit the Dallas County Medical Society website at www.dallas-cms.org for resources regarding the settlement.