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Dentists and Aetna Reach
Agreement to Improve Efficiency and Enhance
Communication
Faster Reimbursement, Reduced Administrative Complexity, Funding
of Foundation to Promote Better Dental Health Highlight Agreement
Upon Court Acceptance, Agreement Would Conclude Litigation
Chicago, IL and New York, NY, Aug 19, 2003 — Representatives
of 147,000 dentists, the American Dental Association and Aetna
(NYSE: AET) have reached agreement seeking to improve communication
and collaboration and lessen complexity in the payment of dental
claims. Dentists and Aetna anticipate that these initiatives will
enable them to operate more efficiently and serve patients and
customers more effectively.
If approved by the court, the agreement would settle a national
dental class action that had been consolidated with a series of
similar actions brought on behalf of physicians. The agreement
follows a proposed settlement of the physician cases announced
on May 22, and given preliminary approval by the court on June
2.
The actions embodied in the agreement are expected to result in
increased predictability and speed of claims payment for dentists,
creating significant value by reducing time-consuming and costly
administrative burdens and giving dentists and their office staffs
more time to focus on their central mission – providing care
to patients. Aetna also expects that these actions will allow it
to operate more efficiently and serve its customers and members
more effectively, with lower administrative costs over time.
Aetna has agreed to pay $4 million to dentists and $1 million
to the ADA Foundation. The costs associated with this agreement
were anticipated and already recorded in the second quarter of
2003 as part of the charge associated with Aetna’s settlement
of the Physician Class Action Litigation.
“
This agreement marks another important
step in Aetna’s efforts to lead the industry in building
a more efficient health care system and strengthening our working
relationship with the health care community,” said John W.
Rowe, M.D., chairman and CEO of Aetna. “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 for our patients.”
“This is a significant agreement for dentists,” said
T. Howard Jones, D.M.D., president of the American Dental Association. “Our
primary concern always has been and always will be patient care.
The reimbursement process and how quickly and accurately we are
compensated should not interfere with patient care, and our member
dentists are pleased that many of their issues were addressed fairly.
We believe this new level of cooperation and transparency will
benefit patients and become a model for the industry.”
Openness and Cooperation
Key elements of the agreement include:
- Establishing a Dental Advisory Committee to provide advice to
Aetna on
issues of concern to dentists.
- A commitment to timely processing of “clean” claims.
- Initiatives to reduce claims resubmissions.
- Disclosure of claims-editing policies, procedures and practices.
- Increased electronic connectivity and direct, web-enabled access
to Aetna systems to verify reimbursement
information and track claims.
Contribution to Foundation to Promote Dental Health
Under the agreement, Aetna will contribute $1 million to the ADA
Foundation, in order to support the foundation’s initiatives
to enhance dental health care for Americans. Among the projects
currently supported by the foundation are:
- Promoting dental health education among traditionally underserved
populations, including addressing racial,
economic, and geographic disparities; this initiative complements
Aetna’s comprehensive
initiative to reduce the risks associated
with racial and ethnic disparities in health care announced by
Aetna on March 5, 2003.
- Promoting children’s dental health, including fluoridation
and education;
- Promoting evidence-based dentistry, including research into
and dissemination of information regarding pharmacology, dental
disease
and standards of care;
- Supporting research that fosters greater understanding of the
relationship between dental disease
and systemic disease.
The not-for-profit ADA is the nation's largest dental association,
representing more than 147,000 members. The premier source of oral
health information, the ADA has advocated for the public's health
and promoted the art and science of dentistry since 1850. The ADA's
state-of-the-art research facilities develop and test dental products
and materials that have advanced the practice of dentistry and
made the patient experience more positive. The ADA Seal of Acceptance
long has been a valuable and respected guide to consumer and professional
products. For more information about the ADA, visit the Association's
Web site at www.ada.org.
The ADA Foundation is the charitable arm of the American Dental
Association and is dedicated to improving health and making lives
better, one person at a time. Since 1991, the ADA Foundation has
disbursed more than $11 million dollars to support such charitable
activities.
Aetna is one of the nation’s leading providers of health
care, dental, pharmacy, group life, disability and long-term care
products, serving approximately 13.0 million medical members, 11.3
million dental members and 11.7 million group insurance customers,
as of June 30, 2003. The company has expansive nationwide networks
of more than 579,000 health care services providers, including
over 349,000 primary care and specialist physicians and 3,589 hospitals.
For more information about Aetna, please visit the company’s
Web site at www.aetna.com.
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