Aetna Revamps Doctor-Patient Policy in Conn.

Aetna Inc. has announced policy changes in its Connecticut plan--a trend observers say will occur throughout its other state health plans.

Changes affecting members of its health maintenance organization include expanded external review of pharmacy claims; standing referrals and emergency care; use of external review for medical necessity and experimental-treatment coverage; and discontinuing referrals for laboratory and radiology services. Women will be permitted to select obstetrician/gynecologists as their principal physicians, and members with serious illnesses can use specialists as their primary-care physicians.

Aetna's Connecticut plan will not force doctors to adhere to its "all-products policy" and will allow physicians with fewer than 100 HMO patients to be paid on a fee-for-service basis. Other changes include allowing physicians not based in hospitals to participate in the health plan of their choice, giving 90 days notice before making "significant" payment or administrative changes and allowing a medical society member to sit on Aetna's Connecticut Quality Advisory Committee.

"The changes are just the beginning of our efforts to improve relationships with physicians," said William H. Donaldson, Aetna's chairman and chief executive officer. The changes will be implemented by the end of 2001.

The insurer's announcement is "a significant first step," said Tim Norbeck, executive director of the Connecticut State Medical Society.

Security Capital Trading analyst John M. Hannon said Aetna's goal might be elusive. "You can't have something that is good for the company, the doctors and the consumers," he said. "You can't satisfy everyone."