Aetna fined $850K for inadequate benefit disclosures

Aetna (NYSE: AET) has paid an $850,000 fine to the New York State Insurance Department for inadequate disclosures on "explanation of benefit" forms to consumers and failure to comply with the state's "Prompt Pay Law" that requires certain claims to be paid within 45 days of receipt, The Street reports.

According to the state insurance department, Aetna failed to issue explanation of benefit forms that identified the service for which the claim was made, contained a specific explanation for not providing full reimbursement for the amount claimed, and contained information regarding the claimant's right to appeal a denial.

Aetna spokeswoman Susan Millerick said the fines covered operations from 2001 to 2005, and that a majority of the findings already have been corrected. "All the utilization review findings noted in the examination were corrected during 2007 and 2008, and all process errors related to [explanation of benefits] have been corrected and [explanation of benefits] issued by our claim systems now have a more consistent look and feel," she told the Hartford Courant.

The Hartford-based insurer agreed to revise its procedures regarding the issuance of explanation of benefit forms and their content, its appeal requirements and the information provided to consumers. Aetna also will review its claims adjudication procedures and develop and submit a plan for improving compliance with the Prompt Pay Law.

To learn more:
- read the N.Y. State Insurance Department press release
- see the Hartford Courant story
- read The Street article

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