National Health Care Alliance Welcomes New Members
Thu Feb 14, 2008
Coalition Sends Letter to State Officials Demanding Consumer Protection
Against Aetna's Propofol Decision
NEW YORK, Feb. 14 /PRNewswire/ -- Aetna Inc.'s decision to greatly curtail
the use of Propofol, the "gold standard" anesthesia agent available to
patients during cancer screening colonoscopies, is causing a growing national
outcry amongst physicians, their associations and consumers. Today, the
Gastroenterologists and Anesthesiologist Alliance (GA Alliance) welcomed the
Georgia Gastroenterology Society to a growing coalition that is confronting
Aetna's decision.
"It is our hope that our participation in this growing alliance will allow
us to effectuate change of this misdirected policy through a meeting with
Aetna's executive leadership," said Dr. Indran Kirshnan, past President and
Member of the Board of Governors of the Georgia Gastroenterology Society. "We
will seek to enlist every patient, every potential patient, every lawmaker,
every commentator, and every cancer survivor who now needs to think about
their next colonoscopy without Propofol thanks to Aetna."
What was once a New York state campaign, has grown into a national
campaign to expose Aetna for making a decision based on what is best for its
own bottom dollar and its corporate executives over the detailed judgments
made by a physician caring for a patient. To confront Aetna, the GA Alliance
sent a letter to elected officials in the five states it currently represents
(New York, New Jersey, Georgia, Virginia and, Delaware) calling for a state-
by-state regulatory and legislative review of Aetna's action which interferes
with appropriate medical practice. By the end of the week all states will be
notified.
Scott Einiger, lead counsel for the GA Alliance, this week has written to
all governors and state attorney generals, explaining, "We hope that your
state and your leadership will carefully investigate this important healthcare
and consumer issue, and take appropriate action to protect the millions of
consumers affected by Aetna's proposed limitation on access to monitored
anesthetic care. Our alliance asks that you carefully investigate this
important healthcare and consumer issue and take the appropriate action to
protect the millions of consumers affected by Aetna's proposed limitation on
access to monitored anesthetic care."
Rising to the Threat
Fortunately, some states legislators are now pushing back against Aetna
and its corporate executives.
The coalition welcomed Delaware Governor Ruth Ann Minner's action this
week when she was joined by Delaware's insurance commissioner Matt Denn and
others to decry Aetna's action.
"We applaud the recent statements of Delaware Governor Ruth Ann Minner,
who decried Aetna's planned actions. Governor Minner has announced that she
will not allow Delaware state employees to be affected by Aetna's wrongful
actions," Einiger said in the letter. "In this, an election year, it is
critical that our political leadership -- both Democratic and Republican --
not be deterred by an organization with resources such as Aetna, which
reported an income of $450 Million for the recent fiscal quarter and almost $2
Billion for previous years, all while raising premiums 14 percent."
Consumer Fraud, Patient Pain
Scott Einiger, a partner with the law firm of Abrams, Fensterman,
Fensterman, Eisman, Greenberg, Formato & Einiger, LLP, and representing the
alliance, stated, "As Aetna has failed to provide notification to its 16.4
million enrolled members, seeking to get the media to do its job by issuing a
press statement about its policy change on the eve of the December holidays,
it is obvious that the insurance carrier is attempting to duck regulatory
scrutiny of their actions."
Einiger warns that Aetna may be facing charges of consumer fraud in many
of the states where they do business. "Consumers have the right to expect
that their insurance policies (either paid for or earned through employment
benefits) should provide the same level of coverage as when it began. Aetna
should not "bait and switch" its members in the middle of their coverage.
Doing so, only forces consumers to accept lesser coverage-one that clearly
promotes substandard care. Clearly, Aetna received approval from state
insurance departments and other state regulatory agencies to offer health
insurance coverage to the public. We fear and expect a consumer fraud and
healthcare crisis will be perpetrated on Americans across the country, if
Aetna's policy is implemented."
Background on Propofol and Cancer
Colon and rectal cancers trail only lung and prostate cancer as the number
one cause of cancer death among Americans, according to the Federal Centers
for Disease Control. This year an estimated 147,000 Americans will be
diagnosed with colorectal cancer and 56,500 will die from this disease, with
an approximate 1-in-18-lifetime probability of developing colorectal cancer.
Currently, only 37 percent of cases are diagnosed when the disease is still
localized.
Despite the fact that hundreds of thousands of Americans are diagnosed
with colon and rectal cancer each year, Aetna unsuccessfully attempted to
change its policy on paying for certain anesthesia in May 2006. Immediately
after, Propofol was accepted by Aetna as a recognized "gold standard" and the
proper and best anesthetic to use for endoscopic procedures. And now, while
other insurers continue to cover the use of Propofol, Aetna seeks to place its
corporate interests ahead of its 16.6 million members.
The GA Alliance includes the New York Count Medical Society, New York
Society for Gastrointestinal Endoscopy, New Jersey State Society of
Anesthesiologists, New Jersey Gastroenterology and Endoscopy Society and the
Georgia Gastroenterology Society, as well as individual physicians practicing
gastroenterology and anesthesiology from across the country. They are
collaborating with other organizations throughout the medical community across
America to effectuate change in Aetna's policy.
SOURCE Abrams, Fensterman, Fensterman, Eisman, Greenberg, Formato & Einiger,
LLP
Trey Ditto for Abrams, Fensterman, Fensterman, Eisman, Greenberg, Formato &
Einiger, LLP, +1-212-843-8000
AI
