Pennsylvania issued Aetna a $550,000 fine following a market conduct exam that found violations in mental health parity laws, according to a March 3 commonwealth news release.
The Pennsylvania Insurance Department reviewed Aetna’s activity from Oct. 1, 2021, through Dec. 31, 2022. The state identified incomplete claims files, along with delays in deciding on claims and improper denials. Aetna was unable to explain those delays, the release said. The department also alleged inaccurate or incomplete assessment and application of benefit limits, as well as “flawed methods” for compliance. The company was allegedly not submitting required claim delay letters during that time, either, according to the government.
Autism spectrum disorder claims were of particular concern, especially for applied behavior analysis. According to the news release, Aetna did not effectively communicate member cost-sharing for autism-related services.
The agreement requires Aetna to reprocess claims and pay members back with interest, improve internal claims processing systems, better elaborate on cost-sharing in benefits documentation, correct denial letters to specify the rejected services and reprocess claims that failed to meet mental health parity requirements. Aetna has one year to execute most of these fixes.
“Aetna has long been an advocate of the Mental Health Parity and Addiction Equity Act. Aetna has received the results of the market conduct exam from the Pennsylvania Insurance Department and will implement, as appropriate, any corrective actions,” an Aetna statement shared with Becker’s said.
Aetna is the latest in a series of plans facing fines for mental health parity violations.
