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Aetna HMO Settlement Could Bring Broad Changes

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"The agreement provides many much-needed improvements," says Texas Attorney General John Cornyn. "This agreement takes the surprises out of managed care." After taking months to negotiate, the Aetna agreement is effective immediately, the state attorney general?s office says.

Aetna U.S. Healthcare may eventually put the provisions of the agreement in place in its other plans nationwide. "The company is in the process of studying the feasibility of these new initiatives in other markets outside of Texas," Arthur Leibowitz, MD, Aetna U.S. Healthcare?s chief medical officer, says in a statement.

Texas also filed suit against the Pacificare, Humana, and NYLCare managed-care plans, and those lawsuits are still pending.

Cornyn has instructed his staff to go after similar deals with the remaining defendants. Even if other HMOs in Texas and around the country adopt similar changes, they?ll still be facing the threat of Congressional action on a "patient bill of rights," a number of class-action lawsuits, and a pending case in the U.S. Supreme Court over how HMO doctors are compensated.

One health-care expert tells WebMD that Aetna had little choice but to agree to the settlement.

"They [the HMOs] were going to lose the power to control the docs anyhow, and instead of just letting it slip away from them, they said, 'Why don't we make a public relations coup out of it?'" says Uwe Reinhardt, Ph.D., a health care economist at Princeton University.

 

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