Notification of Termination to Aetna

January 30, 2014


Dear Mr. Bertolini,

With a deep sense of sadness, I must inform you that I will no longer serve as a physician for Aetna patients under the terms of our contractual agreement, which you most recently unilaterally changed.

I have been privileged and honored to care for thousands of patients covered by Aetna policies since the 1990’s. I have devoted my life to providing the very best, state-of-the-art care to these individuals. We have formed a patient-doctor relationship, which I hope many will chose to continue in spite of my severing ties with Aetna. You see, health insurance has evolved such that insurers and government have inserted themselves smack-dab in the middle of the once sacred patient-doctor relationship. I am called a provider- not a doctor. My patient is now yours- not mine. What I can do as a physician now has strangulating strings and nonsensical numbers attached- to you and government and money-not the best interests of the patients.

Obamacare, the “law of the land”, contains ever-changing-at-the-whim-of-HHS, politically-expedient mandates, rewards, penalties, rules and regulations with which I cannot rationally or morally treat my patients and run a practice, much-less interpret, implement, or comply.

Millions of Americans have lost coverage because of the healthcare law and must now shop on a defective, insecure government website and sign up for more expensive policies through Federal and State exchanges. Only by logging in as a prospective patient did my office manager and I discover that Aetna was selling plans for which I am a provider-effectively selling my services without even asking, much less informing  me that my services would be sold on such a site, under the auspices of new terms with which I will not comply.

Then, after the fact, I received a form letter informing me of Aetna’s “new allowables”. I will not sell my services under such terms. While treated as such, patients and doctors are not commodities worthy of such impersonal, inconsiderate, and cavalier treatment. We choose dignity and personal service over disrespect and form letters.

So here we are, you are getting new business offering health insurance plans featuring my services without my consent under terms which are unacceptable to me. Accept this as my official written notice that the changes that you have unilaterally made to our contract are unacceptable to me and make our contract null and void.  You must explain this to your patients. You must tell them that they have purchased a product that was misrepresented to them and that you cannot deliver. It saddens me to think of the decreased access to care from actual physicians and the shockingly increased costs Aetna patients will now experience because of your choice to collude with big government rather than collaborate with patients and physicians.

Kristin S. Held, MD

151 thoughts on “Notification of Termination to Aetna

  1. Pingback: ‘I will not comply’: Doctor slams Obamacare, sends must-read breakup letter to Aetna | Twitchy

  2. Dr. Held – Sent you FB message but am copying here in case this is a better way to reach you. Just read your epic Aetna letter, and responses from other docs who feel as you do. I don’t know how to “tweet” so I’m trying this route of getting in touch with you – This is a watershed moment of opportunity for those brave enough to go where medicine has not gone before (or maybe where it started out?) – Brave, caring ocs like you need to reinvent the practice of medicine; think and go outside the box to create a new a new medical model that ONLY includes the patients and you the doctors. No insurance companies, no government. As a few have done; it will involve adjustments to money, to the way it’s done – but you deal directly with the patients, who pay you out of pocket; new fee schedule which is supportable by average patients will have to evolve. Either retainer type plans, or simple fee for service plans, again reflecting REAL costs and profit margins, rather than insurance company inflated ones. It’s time – and with the sudden platform your letter has launched you onto, I think you may be the one to rally like-minded docs across the board (MDs, naturopaths, nurse practitioners, etc.) to break the mold and offer REAL medical care and REAL patient/doctor relationships unencumbered by bureaucratic exigencies. God bless you, Dr. Held – if you need any grunt work/leg work/support I’m IN.
    Mercy Huss – just a grandma and American citizen who’s FED UP and ready to hitch a ride with those brave enough to pioneer bottom up solutions to the metastatic, corrupt government/industrial complex that is suffocating this great country. It ain’t gonna come from politicians. :-S




    • Hi Mercy,
      Thank you so much for your response. You are 100% correct in everything you said. I would love to meet and work with Dr. Ben Carson. I have read his books and followed his career. My father is a neurosurgeon, like Dr. Carson, and by association I respect these men, who are my role models. I will never stop fighting this. We must return to the patient-doctor relationship as you related above. I appreciate your support. I will connect with you on Facebook!

      • If I am not mistaken, Dr. Carson has NOT defended the 2nd Amendment publicly, and has NOT said anything on immigration. So you know he’s for it.

        Anytime the ‘elites’ allow someone in, like Carter, he has to tow their line.

        That line being the decimation of this country.

        As a fellow conservative, I at first liked him, but we’d do well to look at ALL of his policies.

        I predict that he will continue with his ‘outrage’ about what’s happening in this country, and then TURN ON US AS THEY ALWAYS DO, when he gets in office.

        He is one of THEM. Make no mistake.

      • Tina, Just because a person like Dr. Carson has a divergence of opinions does not make him less of an advocate of freedom. His positions are based on things that most of us don’t do, research, thought and expression. He is also something else: flexible. He has changed his opinions and viewpoints when challenged with thoughtful arguments.

        I challenge you to analyze his opinions and find any inconsistency. In every case, he supports helping people and is against using the government to help people. He is the ultimate classical liberal, which is similar but not quite the same as a modern conservative.

    • I have been predicting this for many years. I sincerely hope that other doctors will take the same road, the road that should have been taken long ago: of putting patients first and insurance companies last. Thank you! Now, we have to find a way of contacting each other: patients who have opted out of insurance and the doctors who are courageous enough to serve them.

    • The most important factor in healthcare is the relationship between the Doctor and the Patient. The government has tried to make the funding and admin support paramount. It is not. If WE value what’s most important first – and act on that recognition of value, this whole mess will collapse. There are a lot of Docs doing what Dr Held has done though not publicly. They are quietly arranging concierge practices with their patients who value their services enough to pay for them. Thank you so much, Dr. Held, for PUBLICLY opting out. Those promulgating this communist program would have us believe that we who object – both Docs and Patients – are a fringe minority. We are not. We are MOST who value the dignity of human liberty.

  3. PS – You need to talk to Ben Carson – together you guys could REALLY change the game. Show the American people what a real American solution to our problems looks like – and how it really WORKS, unlike the tired, hopeless, top down government bureaucratic SNAFUS that are all the politicians can seem to come up with 😉

  4. Good for you, the lawyers have taken over, they need clients and need to destroy any relationship not controlled and benefitting them primarily.

  5. It’s sad for your patients who will no longer be able to receive your care because they are tied to Aetna, but congratulations to you for standing up for what you feel is right. If we all continue to let government inject itself into our personal lives, we’ll soon be in ‘1984’ wondering what happened.

  6. More doctors need to put out the same kind of letters to the ins companies. Obama care would be a big joke if it wasn’t so sad.

  7. God bless you for having the moral courage to stand for what is right for you and your patients. I can’t even begin to express my disdain for those who elected this inexperienced, unqualified president who is bent on destroying on what was once the greatest country on earth.

  8. Doctor Held,

    I wish you the best of luck fighting Obamacare, for your sake and the sake of your patients. It’s refreshing to hear from an actual doctor who is willing to express their thoughts and feelings on this monstrosity posing as healthcare for all. I have spoken to my doctor and several others in an attempt to get an idea of their thoughts on Obamacare all have side stepped me and given me the we will “wait and see” type of responses.

    I really do hope that you succeed in your endeavor. It sounds like Aetna violated their contract with you, they can’t just go and change it as they see fit and expect you to comply with it. Any first year attorney will tell you if the contract is to be changed it must be approved by all parties involved otherwise as you stated it is “null and void.”

    Thank you for standing your ground, and for wanting to care for your patients care as YOU see fit without government dictating how it should be done or IF it should be.


    Paige Ketcham
    Tacoma, WA

    • True, and I admit, I fear retribution. That in itself is telling and makes me fight harder for the future of my kids, patients and country. We must expose them and dispose of them.

  9. Continue to fight the good fight, Kristin! I left an excellent opportunity to fugill my childhood dream of
    becoming an MD/PhD as I learned mote and more about how unrealistic it would be to practice medicine
    the way I wanted to-that my ultimate decisions and options for my patients were being determined by an entirely uninvolved, inappropriately educated third party. I now specialize in patient safety & quality improvement. I feel I’ve found a kindred spirit in your
    letter. Best wishes to you and the success of your efforts.
    With kind regards,

    • Thank you for your support, Grace. BUT- I am so saddened by the fact that you abandoned you dreams of becoming an MD/PhD. This is the worst part of all-the best and the brightest with the potential to innovate, cure disease…are the very individual who refuse to be oppressed, stifled, and strangulated by the current environment created by the government takeover of medicine. I encourage you to pursue your dreams. Medicine is a noble and rewarding profession. I am fighting to win it back for those like you.

      • Well said Doctor; This is only one example of what Frederic Bastiat referred to as “Things that are unseen”. The consequences of Obamacare, having almost nothing to do with actual healthcare, will be painfully felt for generations to come. My sincere wish for you Doctor, is to stay safe from bureaucracy.

  10. Bravo! Bravo!!! If enough doctors and nurses do this, the healthcare insurance industry will be forced to take notice as well as the government. I urge full repeal. I know it will be messy, but no more so than this debacle we face with Obamacare. The issues that should have been addressed first are Medicare and Medicaid fraud and Tort reform. With fraud cases, there should have been mandatory loss of assets, loss of license to practice and significant jail time. Any cases found to be without merit or scam suits brought by ambulance chasing attorneys such as “planned” accidents with “back injuries” etc, that would pay out hundreds of thousands of dollars would be a loss of license to practice law and significant jail time. As you can see, I would rule with an iron fist because this degrades our health system to the point of utter chaos for all Americans.

    • Hi Jason,
      I have not contacted Senator Cruz, but that is a great idea. I respect him as a true statesman willing to put himself in the crossfire to defend our Constitution.
      Thank you for the suggestion and the link!


      • Don’t forget Mr. DeFazio, too. He has been on the side of Social Security recipients and Veterans, and he voted against Obamacare.

  11. What a sad state this Obamcare has done to millions of Americans and their personal relationship to their doctors . Obama and his minions have destroyed this once beautiful country. We need to take back America by voting every single Democrats out of office starting this mid term election 2014 and this is the only solution.

  12. God bless you, Dr. Held for speaking out. You absolutely defined the terms under which your services are being hawked to a gullible public without your consent. I would encourage all Christian people to join medical sharing ministries, for many reasons, one among them being the ability to deal with physicians on a cash basis. They are to Obamacare what homeschooling is to public school!! Opt out! Starve the beast!

    • Hi Teresa,
      You are 100% correct. Thank you for your response, and thank you for your service to others as an R.N. My mom, sister, and many of the most trusted and respected women in my life are R.N.s. God bless you!

  13. Dr. Held, I deeply appreciated your rational response to Aetna’s presumption. I think you have an excellent grasp on certain realities of this new slavery foisted upon us by a new orthodoxy and the rent-seekers who are feathering their beds with our freedoms, setting up shop in our bedrooms, all the while, feigning bewilderment when we object.
    Having fought this thing, tooth and nail, and even as I will continue to fight it, I’ve been mystified all along wondering why your righteous indignation hasn’t been more widely shared by your colleagues.
    I’ve heard most of the excuses mainline doctors have offered, such as having been blindsided or overwhelmed by the unscientific political system of our nation, but none of the excuses I’ve heard has helped me understand the general apathy of the medical community.
    Even now, a more general refusal, like your own, to this outrageous treatment would bring this ridiculous political fight to an end.
    To many medical professionals who are, only now, grumbling at the weight of their chains I have asked, “where were you three or four years ago?”
    One certainty of a free republic is a clumsy politics, often run by stupid people who must be checked. It’s the “eternal vigilance” Jefferson described as its price, wherein another certainty is “if you cannot be bothered with politics, then politics is certain to bother with you.”
    I applaud you for firing this soulless corporation, but I suggest you also consider firing your professional associations and their lobbyists, as well as not a few incredibly stupid professional politicians who have less understanding of the Constitution from which they receive their power and which they are sworn to defend than they do lancing a boil.

    • Hi Joel,
      If only I could articulate this mess as well as you do. You are 100% on the mark. My blogs about “implement and comply” and “complacency ad complicity” touch on some of the issues regarding physicians. We are to blame as a profession for allowing this to happen on our watch. This is multifactorial and I will address this in my next piece. Sadly, physicians have become so entrenched in the day to day struggle to practice medicine, that essentially we were caught with our heads in the sand. Now, I hear physicians say they are actually afraid to speak up. The fear is twofold: 1. Medicine should not be political. We do not want it to be political. We do not like to play politics. We do not want to alienate our patients. 2. We are afraid of the government. Yes, we are. We are afraid of IRS audits, being demonized, RAC audits, huge financial penalties (up to $1.5M for a HIPAA violation), and now even imprisonment (see the case of Dr. Natale). I address this in one of my posts. We now fear loss of licensure and loss of insurance contracts. Worst of all, right under our noses, The AMA was infiltrated by far-left, socialist cronies of Valerie Jarrett, the Obamas, Ayres and their operatives. You will be stunned when you google up Dr. James Madera. current CEO of the AMA. He is former Dean of the University of Chicago Medical School who resigned after scandal involving Michelle Obama. I know you would find it fascinating and frightening.I admit, I’m nervous, but if we don’t fight this, who will? Physicians will be to blame for the demise of our Constitutional Republic. I forgot to mention, we are too trusting. WE operated from truth and trust. We presume our elected officials do the same. Sadly, they do not. The mentalities of physicians and politicians are polar opposites.
      Thanks you for you response,

  14. Dr. Held, thank you for your letter. It should be in the news! I have such fear for Americans and the America way of life. Being a citizen of the greatest nation on earth (in my opinion) means nothing to Washington. In his earlier books, Obama spoke of making America a 3rd world nation which is fastly approaching. What would it look like if doctors were able to get rid of all the insurance, patients would pay less upfront cash and could purely offer the best care to their patients? How about hospitals? Big BITE! God have mercy.

  15. Pingback: Obam(ACA)re: What Doctors are Doing in the Fight | The Universal Spectator

  16. Pingback: The Quagmire And Casualties Of ObamaCare | Sword At-The-Ready

  17. Dr. Held,
    Thank you so very much for your stand! My PCP retired in October–the day before DisasterCare went into effect. I am a hospice RN and I wonder what effect all of this is going to have on my patients. Will the hospice benefit from Medicare be the next thing to be cut?
    I am also 61. If I have to go into the hospital for a problem, is that “death committee” going to say I am unworthy of care? I am hoping that because I have an employer sponsored health care plan that will be a non-issue.
    I pray daily that Christ will return for His Church before our country is totally destroyed!

    • Hi Cindy,
      Hospice is amazing. My mom is an RN and when her brother passed hospice was there for us all the way with direction, dignity, and compassion. We must find a way to do what is right in spite of this horrific government debacle and intrusion into the most sacred aspects of our lives. An alternative medical universe is emerging. Yes, we must pray gov does not shut this down too. I too pray we return to God as a loving, generous people.

  18. I’ve been waiting, so far, for 3 days to hear back from my doctor’s office how much they’ll charge me to pay for a quick med-check just to get my prescription refilled – Obama killed my health insurance and so I’m going to pay cash for services.

    Still waiting; they can’t seem to give me a simple price quote for a 20-minute office visit to take blood pressure, ask the usual questions and check my chart.

    Sheesh. I think I’ll drop off a copy of your letter to Aetna when I finally get an appointment – I’ve gotten lots of blather in the mail about how patients are the highest priority; my doc needs to stand up for his own business and livelihood as well as his patients!

    Thanks, Doc Kris

    • Hi Jim,
      Where do you live? There are many doctors who have low transparent fee schedules. We need transparency. There is a site called Medibid that posts fees. Depending on where you live, I could direct you to low cost superb care! More often than not you can get care for less by not using your insurance!

      • Fairly far from you, doctor; Olympic Peninsula WA State.

        I’m impressed that you take the time you do, in addition to your practice and family, to fight the good fight. The best way to take down Obama’s monstrosity it to boycott it, starve it of cashflow – that’s all political parasites understand . . . money.

      • Thanks for the tip about Medibid; bookmarked their site and if I can’t work out a satisfactory arrangement for cash prices with my current doc office, it looks like a worthwhile alternative to check out.

  19. How heartening, Dr. Held, to read your letter and some of the responses, especially that of Joel Raupe, to it! Well done! It’s good to see that testicular fortitude is alive and well. You go, girl!

  20. God Bless you Dr. Held for the excellent letter you sent to Aetna and for your courage. I am an 84 year old Korean War vet and am proud to know there are Doctors like you willing to stand up to this Obamacare disaster.
    I may need to have cataract surgery on my left eye and may be told by the Government that I’m too old.
    My wife and will keep you in our prayers for you and your family’s protection and safety.

    • You are never too old to see! I am operating on a 95 year old lady this week and have operated on one precious lady when she was 100. She drove herself to church, grocery store and beauty salon and lived to 104. She loved doing intricate handwork and did “Tatting” with great love and joy after her cataract surgery. Before her surgery she could not drive, sew, or enjoy the quality of life that came thereafter. God bless you.

  21. Kristin – great letter. If you want a more conservative area to practice, move to Lake County, FL near Orlando. Many well financed retirees and many doctors standing up to Obamacare. You can see some videos of them at my blog’s YouTube page FiscalRangersFlorida . Cheers.

  22. Pingback: "I will not comply" - A doctor speaks

  23. Pingback: An Open Letter to Aetna from a Texas Doctor (Reblog) | Heart of Texas Blog


  25. I am pleased you are fighting now. For me I lost the fight. I am a Psychiatrist who came up against the State of Mo. They took me on only after I had bacterial meningitis and survived. They broke 4 federal laws and a state law to get me to quit. About what they had been upset for yrs was I paid malpractice for general Psychiatry. My chief residency was in Consultation – Laiaison (now known as Psychosomatic Illness). I maintained my CME in many areas. I left hospitals bc of insurance requiring I bargin nearly daily. I could never return to a hospital after 2004 bc if H. Clinton and her team putting patients on a flow chart that is based on the Bell Curve (I was once certified in Electronics Quality Control and know my statistics very well; this prior to reentering college then medical school). I cannot let 10% of patients be discharged knowingly to go home to solve their problem or die (and yes many have died). This is against my medical oath (note my medical oath was as important to me as my marriage oath that I modified it to be a promise I could keep for the rest of my life. I did it just as I modified my marriage oath: live honor and negotiate, there is nothing about obey and the marriage is 38+ yrs. Oaths are contracts and I made mine specific!)
    After 2010 with ACA passed the FDA would have legal grounds to sanction me. The FDA now determines “your scope of practice” ; prior to this your education determined it. Ever since I was in Medical school I was fighting the removal of elements of my medical education. I got up early and joined Neurology rounds to get my radiology training (removed by the state). I took extra classes in real nutrition. I’m board certified in Psychotherapy. There simply was not enough money to pay for the board certification in Neuropsychopharmacology but I have the education.
    So I was forced into full disability (when they were done with me I had lost my ability to write due to stress on a damaged brain) by 2008.
    Under ACA, I cannot go back! Writing more than ever is more important to the job. I cannot keep up the speed of a day. The brain damage reduced me to doing, on a good day, 2 multitasking mental/physical things. You and I both know that 5 are a requirement.
    Sad thing is I would not have been this badly damaged if our urgent cater system did not push docs. This doc asked me who’s the doc when I asked for a hospitalization. She did not do a full Neuro exam. Hurry in and hurry out. Sadly the areas affected caused me not to be able to express I was stroking and my husband is not a doc. He did not know I was stroking. This doc had a counter teansference reaction and it led her down the wrong pathway. The second stroke was in Right upper prietal thus caused left hemipariesis (I relearned to move left side). And no on this town, I could not win a medical suit. I have my megar disability.
    I still hold my Kansas licenses (exempt). I’m not threat to a patient but I cannot gurantee practice daily (weather pressure changes cause neurological symptoms) and I cannot do modern governmental medicine at the pace demanded. Btw my data bases are intact!
    Well I lost my 10 yr fight with the state of Mo bc I couldn’t afford both energy nor monitary to fight them. Now there is no psychiatrist in this area that sees a patient for 45 min. It took many professionals to replace me for my 300 patients and that took me 9 months to find those replacements.
    I have no love of congress bc while this was going down, it was at the time they were forcing Psychiatrists (always first tested as to how far docs can be pushed) to group. No option to group for me bc the group would have to be 3, myself and two others. Well there was only 1 other available and grouping with psychologists did not count. So M/M paid me <1/4 what other specialist were paid in 2007. I could not afford to stay in business.
    Please fight hard.

  26. Dr. Held,
    As a Registered Nurse, during my long career as a peri-operative nurse, I have been honored to work with many great Ophthalmologists. I know the great good you, and many like you, do for their Patients daily. To reduce this Physician/Patient relationship to mandated “allowables”, without discussion, with agencies such as Aetna, the ACA, AARP is more than insulting. It takes the individual patient care out of the hands of the Physician and Patient and reduces it to a spread-sheet and profits. It exposes Patients to diminished results that can reduce quality of life. And it can place Physicians in breach of trust and loss of reputation situations that can further lead to damaging lawsuits by making them choose between “necessary” care versus “adequate” care in the face those “allowables”. That you stand up and draw a line is courageous in this day and age of ACA (that seems to be quickly evolving to “Single Payer”) shows a caring spirit for your Patients.

    I am passing this along to my friends…and to the Docs I’ve worked with. May God Bless you.

    Christine L. Armstrong, RN

  27. A million “Thank you’s”. I wonder what would happen if doctors from all over the US publicly stated the same message with such force that it rattled the WH and Congressional windows, and thus began to restore medical sanity in this nation.

  28. Dr. Held – I am pleased and impressed at your continued fight against the abomination that is Obamacare. I would like to see your template for reform from the site be adopted by our candidates for Senate and Congress as the alternative for actual health care reform (vs. health insurance). Will that group be active during this campaign season? If so I want to donate time and treasure to the best of my ability. Keep up the good fight, and know that you have many supporters!

    PS I graduated high school with you and it is wonderful to see the success you have made of your life – I hope and pray that all good things continue for you.

  29. Seems to me is a little late for American Physicians to be waking up to the facts of socialized medicine and what it means to the doctor -patient relationship AND to the KNOWN great reduction in the quality of care that is part of the same socialized medicine formula. These FACTS were known in 2008 when the Democratic Party supported the Marxist Socialist Obama and Obama OPENLY told everyone where HE would take American Healthcare if elected. AND in 2008 the sound from the Health Care Industry in total was a deafening SILENCE! Well now the proverbial chickens are coming home to roost and across the board everyone BUT the Marxist Socialist Democrat Elites of America are feeling the pain of only the first steps of Socilaized Medicine. Nice letter doc and I do not blame you personally…I blame the “head in the sand” fearful approach of YOUR industry colleages and their lack of charcater and values to stand up to and speak out OPENLY to the American People regarding the “reality of socialized government -controlled healthcare”! 2016 is coming and Hillary the Original Socialized Medice Queen will becoming to “help us” with Health Care….And will American Healthcare industry cringe again in fear and “give her a pass” too just like Obama in 2008?

  30. Excellent post. We the people, whether doctors or patients, need to unite and fully reject Obamacare. It is a nightmare for everyone. If we unite and do not participate on any level, then it implodes under its own weight.

    Many think that there is nothing that we can do. Well, there is power in knowledge and there is power in numbers. We can reject Obamacare. We can reject all of those in government who have betrayed us. (hint…this is all of them. Not one has stood completely with the Constitution). Firing most (or even all) of them would send a clear signal that we will not take it anymore. This must be done in the primary. In the general, few will cross party lines, so the same incumbent almost always wins…and we get the same horrible government.

    God bless you in your stand against Obamacare. I truly pray that it brings a huge benefit to you and/or leads to the collapse of Obamacare so that it is not our healthcare system that implodes.

  31. Pingback: Due to Obamacare, Doctor opts out of being an Insurance provider | Forever America

  32. Bravo Dr. I am appalled by the people of this natiom allowing Goverment to put Ins. companies in the loop for profits from others work.The one thing that is very clear from this,is that the ins. lobby is strong and well funded.Keep fighting the good fight.As to the “Wait and see”ers”. I waited and saw my premiums rise,my copays go up and my health care be dictated by Non medically trained bean counters.I’ve seen enough. Good luck with your fight.

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