AUSTIN - Texas Attorney General John Cornyn today announced a landmark agreement with Aetna U.S. Healthcare, Inc., one of the nation's largest health benefits companies, for its Texas based HMO members - all without increasing the cost of premiums. The agreement also serves as a model for all Texas health plans to follow.
"Throughout these lengthy negotiations with Aetna, my priority has been protecting the consumer. As a result, consumers will have the information and power to make truly informed choices about their health care. This is a real indication of how consumers benefit when government and business work toward the common goal of improving healthcare," Attorney General John Cornyn said.
"The agreement provides many, much-needed improvements. Especially important are the provisions ensuring that any financial incentives to doctors do not affect the quality of care received by patients and the provisions clarifying and disclosing how Aetna makes coverage decisions. This agreement takes the surprises out of managed care."
Notably the agreement creates a new consumer Ombudsman office for Aetna's Texas health plan members and provides Texas physicians with flexibility in which products they choose to participate in.
Details of the agreement are included in an Assurance of Voluntary Compliance (AVC) filed today in Travis County District Court. The agreement covers Aetna U.S. Healthcare's Texas commercial HMO members and those of Prudential Healthcare Plan, Inc., which Aetna acquired last year.
"I want to express my support for this voluntary agreement and commend both Aetna and Attorney General John Cornyn," said Texas Insurance Commissioner Jose Montemayor.
Under the AVC, Aetna will:
The AVC resolves the lawsuit pending between the Attorney General and Aetna concerning Aetna's HMO practices. Today's agreement does not resolve the lawsuits filed by the State of Texas against other HMOs. The Attorney General has instructed his staff to contact the other defendants - Pacificare, Humana and NYLCare - and seek their compliance with the provisions of this AVC.
The Aetna AVC is effective immediately and will be fully implemented over the next 90 days, with respect to Aetna U.S. Healthcare. With respect to Prudential, implementation will be completed by Jan. 1, 2001.
To view the AVC, click here.
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