The Pennsylvania Insurance Department (PID) on Tuesday fined Aeta $550,000 for past violations of mental health parity laws.
"A few years ago, Gov. (Josh) Shapiro tasked the PID with making mental health parity a true reality for Pennsylvanians," Insurance Commissioner Michael Humphreys said in a news release. "Today's announcement is another giant step toward that ultimate goal and represents just one of the many ways PID protects consumers. Our front-end compliance reviews and back-end enforcement are among the most robust in the country, and we will continue to enforce Pennsylvania laws and regulations to the fullest extent of our statutory authority."
The fine is based on the agency's examination of Aetna from October 2021 through December 2022. This exam found:
- Incomplete claims files, especially for Autism Spectrum Disorder services;
- Delays in approving or denying claims and failure to explain these delays;
- Improper claim denials because of poor internal communication about prior approvals and other insurance coverage;
- Failure to clearly explain member cost-sharing for ASD services; and
- Violations of mental health parity laws, including incorrect or incomplete analysis and application of benefit limits.
The department also found broader "universe" violations, including flawed methods for reviewing mental health parity compliance and failure to clearly list cost-sharing for ASD services in most plans. The company also confirmed it was not sending required claim delay letters during the exam period.
Under the consent order, Aetna must reprocess claims that were handled incorrectly and pay members what they are owed, with interest; improve internal systems to make sure claims are processed correctly and on time; clearly explain cost-sharing in benefit documents; fix denial letters to clearly explain why services were denied; and reprocess claims that did not meet mental health parity requirements. Most of these corrective actions must be completed within 12 months, with regular reports to the department.
"Aetna has long been an advocate of the Mental Health Parity and Addiction Equity Act," the company said in a statement to Becker's Payer Issues. "Aetna has received the results of the market conduct exam from the Pennsylvania Insurance Department and will implement, as appropriate, any corrective actions."
This was only the latest in a series of recent mental health parity fines in the industry. In January, Georgia fined 11 health insurers nearly $25 million for violating state mental health parity laws.
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