Your article was successfully shared with the contacts you provided.
Insurers have come under scrutiny in the past for policies rejecting claims for visits to the emergency room that they deem unnecessary. The latest to find itself in hot water? Aetna, which has been fined $500,000 by California’s Department of Managed Health Care after a sampling of claims from 2019 found it had denied 93% that it deemed unnecessary.
“The plan’s failure to follow California law for reimbursing emergency room claims is unacceptable,” said acting DMHC Director Mary Watanabe said in a press release. “This has resulted in Aetna wrongfully denying emergency room claims. Aetna must follow the state’s health care laws to ensure enrollees have access to the care they need.”
Complete your profile to continue reading and get FREE access to BenefitsPRO.com, part of your ALM digital membership.
Your access to unlimited BenefitsPRO.com content isn’t changing. Once you are an ALM digital member, you’ll receive:
Critical BenefitsPRO.com information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events.
Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
Emily Payne is managing editor at BenefitsPRO. A Wisconsin native, she spent the past eight years writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.
Competing successfully in today’s labor market means moving away from reactive recruitment practices that are overly reliant on compensation. Instead, take a more strategic approach with innovative add-on health benefits that complement core benefits and can be tailored to the needs and wants of a diverse workforce. Download this guide to learn how.