Skip to content
My WebMD Sign In, Sign Up

Information and Resources

As Texas Goes, So Goes the Nation?


WebMD Feature

May 29, 2000 -- The agreement reached last month in the lawsuit brought by the State of Texas against Aetna U.S. Healthcare may have solved the company's problems there, but two other key states, New York and Connecticut, are moving forward with probes aimed at reviewing the insurance giant's practices.

Attorneys general in both states signaled that they will continue their high-profile investigations of Aetna even as the company began taking steps to institute the provisions of its Texas pact nationwide.

Recommended Related to Health Ins & Medicare

Health Care Reform and Children: FAQ

The Affordable Care Act now extends a number of additional benefits to children.  WebMD readers have written in with questions about their rights and challenges they’ve faced when trying to insure their young adult children. Here are answers to the most common questions.

Read the Health Care Reform and Children: FAQ article > >

Sued by Texas in 1998 for allegedly using financial pressure to force doctors to cut back on necessary medical care, the company signed a no-fault settlement agreeing to voluntarily change many of its policies there.

Sea Changes in Connecticut

Aetna had hoped it could use the Texas settlement as a model for plans in other states where the policies and protocols of its widely used Health Maintenance Organization (HMO) are under investigative review. But in mid-May, after the company offered to make some changes in its procedures in Connecticut, Richard Blumenthal, the attorney general in that state, would say only that the firm's offer was a "good start." Blumenthal said his office's probe into Aetna's work in Connecticut would continue, and that he wanted the firm to consider changing its practice of paying a set fee for each patient ("capitation"), which, he said, "wrongly shifts the risk of health care to physicians and their patients."

William Donaldson, Aetna chairman and CEO, told a meeting of the Connecticut State Medical Society that his firm hoped its proposals would be given a fair assessment by the state's government and physicians. "My fervent hope is that we can form a more respectful and collaborative partnership that makes the system work better for everyone," he said. And Tim Norbeck, the medical society's executive director, responded that Donaldson's statement was "an indication that Aetna is sincere about wanting to reach out and partner with physicians."

What About New York?

In New York, State Attorney General Eliot L. Spitzer has been noticeably silent on the issue since Texas and Aetna settled. In New York, Aetna is considered the worst of the managed care companies when it comes to paying claims and dealing with providers. In four rounds of fines on the industry over the past 12 months, the New York Insurance Department has hit Aetna with more penalties than any other firm for not paying claims promptly. Officials in Spitzer's office, which has been examining Aetna's procedures for approving or denying claims and the late payment of claims, will say only that the pact does not fully address Spitzer's concerns.

In New Jersey, a doctor filed a class action lawsuit against Aetna in October, alleging that the HMO took advantage of its position by failing to pay doctors on time and, in some cases, failing to pay at all. Similar suits have been filed in Philadelphia and California.

Michael D. Towle is based in Chantilly, Va., and writes regularly on health and legal issues for WebMD.

Hot Topics

WebMD Video: Now Playing

Click here to wach video: Dirty Truth About Hand Washing

Which sex is the worst about washing up? Why is it so important? We’ve got the dirty truth on how and when to wash your hands.

Click here to watch video: Dirty Truth About Hand Washing

Popular Slideshows & Tools on WebMD

feet
Solutions for 19 types.
row of colored highlighter pens
Recognizing symptoms.
build a better butt
Check your BMI.
man with indigestion
How to build a better butt.
MS Overview
How to identify that bite.
stressed working woman
What to watch for.
brain scan with soda
Tips to kick the habit.
fat caliper
Tips for living better.
Woman running
And how to fix them?
lone star tick
Check your BMI.
young woman in sun
What Do Your Dreams Say About You?
Girl drinking orange juice
How to keep yours at bay.

Pollen counts, treatment tips, and more.

It's nothing to sneeze at.

Loading ...

Sending your email...

This feature is temporarily unavailable. Please try again later.

Thanks!

Now check your email account on your mobile phone to download your new app.

Women's Health Newsletter

Find out what women really need.