Aetna Announces Settlement of Dentist Lawsuit

As expected, health insurer Aetna on Aug. 19 announced the settlement of a lawsuit filed by the American Dental Association over alleged improper billing and reimbursement practices, the Wall Street Journal reports (Fuhrmans, Wall Street Journal, 8/20). Under the settlement, signed on Friday, Aetna will pay $4 million to 40,000 to 50,000 dentists who provide services to Aetna members, contribute $1 million to the ADA Foundation and pay as much as $1.25 million in attorney fees for the dentists (Kaiser Daily Health Policy Report, 8/19). Aetna also agreed to establish an advisory committee of eight dentists and a company representative to recommend billing practices; increase the number of automatically processed dental claims; pay properly submitted electronic dental claims within 15 days and properly submitted paper dental claims within 30 days; and provide dentists with Internet access to track claims (Levick, Hartford Courant, 8/20). David Carter, a spokesperson for Aetna, said that the settlement would apply to dentists who have provided services to Aetna members since Aug. 15, 1995 (Singer, AP/Philadelphia Inquirer, 8/20). Judge Federico Moreno of the U.S. District Court in Miami must approve the settlement. Both the ADA and Aetna will likely seek class-action status for the lawsuit for the purposes of the settlement (Hartford Courant, 8/20). In the lawsuit, the ADA and two member dentists in 2001 alleged that Aetna failed to reimburse out-of-network dentists for the "actual charges" for the treatment of Aetna members. The lawsuit also alleged that Aetna committed libel against the dentists when company officials told members that Aetna would not reimburse the dentists for actual charges because they had "engaged in misconduct by attempting to charge excessive and unreasonable fees." In addition, the lawsuit accused Aetna of "unlawful interference with the dentist-patient relationship" (Kaiser Daily Health Policy Report, 8/19).

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Dr. John Rowe, Aetna chair and CEO, said, "Our expectation is that by introducing specific business-practice initiatives and new levels of transparency in our relations with dentists, we will achieve a common goal of better dental health." ADA President T. Howard Jones called the settlement a "significant agreement for dentists" that could serve as a model for other lawsuits between dentists and insurers (AP/Philadelphia Inquirer, 8/20).