The Aetna Settlement

In May of 2003, Aetna U.S. HealthCare agreed to settle a series of lawsuits by executing a Settlement Agreement with 18 medical societies, physician plaintiffs and their attorneys.

Highlights of the agreement included:

• $100 million Settlement Fund for Physicians
• $20 million Foundation
• $310 million estimated costs of "prospective relief"--the costs to Aetna to make business changes required by the Settlement Agreement
• Reform of Aetna's business practices affecting physician practices
• Disclosure and transparency in claims payment and medical review decisions
• Streamlined compliance and appeals processes for resolving disputes
• Formation of a National Advisory Committee of Practicing Physicians, a Billing Dispute External Review Board and Medical Necessity External Review Process

To fulfill the last requirement, an Aetna Physicians Advisory Committee was formed. View the List of Aetna PAC members.

Latest Aetna News

• Effective January 1, 2007, Aetna Will Consider Resubmitted Claims for E&M Visits Appended by a Modifier 57 More details...

Aetna Compliance Information

Major Provisions of the Aetna Settlement Agreement Extended for One Year

The termination date for most provisions of the Aetna settlement agreement have been extended until June 2, 2008. This includes an extension of the changes in business practices made by Section 7 of the agreement. The billing dispute resolution process has not been extended. Please contact the Compliance Dispute Facilitator, Cameron Staples, Esq., (203) 821-2000, if you believe there have been any violations of the agreement.

Download the Memorandum of Understanding, extending the Aetna settlement agreement for a period of one year.

• Aetna Step-by-Step Compliance Dispute Procedure
• Aetna Compliance Dispute Form

Aetna Documents Concerning Notice and Filing of Claims

• Mailed Notice of Settlement to Class Members
• Preliminary Approval Order of Aetna Settlement
• Order Granting Class Counsel's Petition for Attorneys
• Supplemental Final Approval Order

Additional Aetna Settlement Information

• Settlement Agreement
  • Part 1
  • Part 2
  • Part 3
  • Part 4
• Settlement Exhibits
  • Exhibit A: Proof of Claim Form
  • Exhibit B: List of Class Counsel
  • Exhibit C: Compliance Dispute Claim Form
  • Exhibit D: Order Approving Settlement, Certifying Class and Directing Entry of Final Judgment
  • Exhibit E: Notice of Proposed Class Action Settlement with Aetna
  • Exhibit F: Order Preliminarily Approving Proposed Settlement
  • Exhibit G: Notice of Proposed Settlement with Aetna
  • Exhibit H: Start Date of Section 7 Committees
  • Exhibit I: Pre-Certification List as of May 2003
  • Exhibit J: Term Sheet for Not-For-Profit Medical Foundation
• Letter from Charles Cutler, M.D., Aetna's Chief Medical Officer, regarding Addendum to Physician Agreement
• Addendum to Participating Physician, Physician Group And Physician Organization Contract
• Modifier 57 Information and Claim Form

Aetna Signatory Societies

• Original Signatory Societies
• Additional Signatory Societies
• Aetna Additional Signatory Medical Society Joinder Form