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National Health Care Alliance Gains New Members Against Aetna's New Anesthesia Policy
Date:2/1/2008

Consumer fraud lawsuit is imminent if Propofol coverage isn't reinstated

NEW YORK, Feb. 1 /PRNewswire/ -- The drumbeat directed towards Aetna to immediately retract its refusal to cover Propofol under all circumstances is getting louder. And as more organizations join the Gastroenterologists and Anesthesiologist Alliance, a call to file a consumer fraud lawsuit against Aetna is growing closer.

What was once solely a New York State issue has now become a national campaign.

Just days after a letter was sent to Aetna's Corporate Counsel and high-level executives demanding a meeting to discuss the importance of covering Propofol, the New Jersey State Society of Anesthesiologists, and the New Jersey Gastroenterology and Endoscopy Society, as well as individual and group physicians practicing gastroenterology and anesthesiology from across the country have agreed to join the GA Alliance and its already existing members, which include the New York Society for Gastrointestinal Endoscopy, and the New York County Medical Society.

Scott Einiger, lead counsel for the GA Alliance and Senior Partner in the Manhattan Division of Abrams, Fensterman, Fensterman, Eisman, Greenberg, Formato & Einiger, LLP, indicated that he was "pleased to welcome our colleagues from other states to join forces with us to combat consumer fraud." John Fanburg a partner with the law firm of Wolf Block and counsel for the New Jersey State Society of Anesthesiologists and the New Jersey Gastroenterology and Endoscopy Society stated, "We are pleased to participate and join forces with this growing alliance. It is our hope that we can directly effectuate change in this policy through a meeting with Aetna's executive leadership."

Aetna's recent decision to stop reimbursing for the use of Propofol is at odds with other national healthcare organizations. Recently, United Health Care decried such a decision and announced that it will come forward to announce that they will continue reimburse for Propofol's use -- in a stark contrast to Aetna's decision.

"Working together with leadership from other state societies shows that this is a national issue, which needs to be redressed immediately," said Dr. Scott Tenner, President of the New York Society for Gastrointestinal Endoscopy. Dr. Ervin Moss, Executive Medical Director of the New Jersey State Society of Anesthesiologists stated that "We cannot stand on the sidelines and watch Aetna enforce its judgment that overrides the professional opinion of an entire medical community. Aetna's new policy strips away the rights of physicians, and the implications for the health of patients throughout the country are enormous."

Background on Propofol and Cancer

Colon and rectum 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 rectum 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 organizations, such as, the New York Society for Gastrointestinal Endoscopy, New York County Medical Society, New Jersey State Society of Anesthesiologists, and the New Jersey Gastroenterology and Endoscopy 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.


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SOURCE Abrams, Fensterman, Fensterman, Eisman, Greenberg, Formato&
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