Doctors drop Aetna, cite red tape glut

Friday, May 8, 1998

BY TIM BONFIELD
The Cincinnati Enquirer

About 20 Tristate obstetricians and gynecologists -- including several high-profile specialists -- have terminated their contracts with Aetna U.S. Healthcare because, they say, the insurer has added too much red tape to their jobs.

"I've been in practice for 30 years. Our group has contracts with all sorts of managed care plans . . . but this is the first contract we have ever terminated," said Dr. Gene Burchell, one of six doctors in Ob - Gyn Specialists of Northern Kentucky and chairman of obstetrics and gynecology at St. Elizabeth Medical Center.

Dr. Molly Katz, a Mount Auburn gynecologist and president of the Academy of Medicine of Cincinnati, said she refused to renew her contract because "you really had to treat your patients differently if they were Aetna patients."

The terminations mean that hundreds of Aetna's estimated 33,000 local HMO members will have to find new doctors, which can be especially disturbing to women who have developed close relationships with their gynecologists.

Aetna, however, reports that it still offers more than 240 local ob - gyns.

"The implication that our networks in the Cincinnati area are losing physicians in large numbers is simply not true," an Aetna spokeswoman said. "We do not anticipate access problems for members."

Aetna, which merged with U.S. Healthcare in 1996, operates in 18 counties in Southwest Ohio, six in Northern Kentucky and four in Southeast Indiana.

The company claims a long history of emphasizing women's health care, including being among the first HMOs to cover mammograms at age 40.

Even so, doctors raised several complaints about Aetna's new Women's Health Program and its recent efforts to get doctors to agree to "all product contracts."

For example, the new women's health program requires ob - gyns to fill out more referral forms, seek pre-admission certifications in more situations, and use billing codes that are unique to Aetna. Doctors say the dispute has never been about Aetna's payment rates, which doctors say are reasonable.

The issue has been who controls patient care.

Many women consider their gynecologist their primary care doctor, Dr. Katz said, which means gynecologists may end up dealing with complaints about depression, fibroid disorders, migraine headaches, even domestic violence.

Previously, Aetna paid ob - gyns for such treatment. Now, it won't.

"Our philosophy is that we treat the whole woman," Dr. Katz said.

Aetna's spokeswoman, however, said most ob - gyns support its women's health program: "It has been one of our most well-received, successful programs across the country."



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