Missouri Gov. Jay Nixon (D) announced that the state has reached a $4.5 million settlement with Aetna following two insurance law violations. It's the largest such settlement in state history.
One violation involved coverage for the diagnosis and treatment of disorders on the autism spectrum. Under Missouri legislation passed in 2010, insurers must cover Applied Behavioral Analysis, a type of therapy used to treat autism.
Aetna spokesman Rohan Hutchings told the Associated Press that the insurer told members that the autism insurance was optional but did not require members to accept or deny the additional coverage. Hutchings added that Aetna will pay for claims that were incorrectly denied at 9 percent interest.
Aetna admitted to violating the autism mandate in 2012 and paid a $1.5 million fine under a settlement agreement, the governor's statement said. However, the insurer failed to "untertake a full and complete audit to ensure compliance with all Missouri insurance mandates," according to the statement.
One such mandate: A 1983 law requiring Missouri women to buy optional insurance for elective abortion coverage. According to the AP, Aetna has covered nine elective abortions without additional insurance riders since paying the fine and agreeing to conduct the audit in 2012.
The settlement subjects Aetna to a three-year monitoring period by the state Department of Insurance. If Aetna complies with the agreement, one-third of the $4.5M fine will be returned, the statement said.
Recent state settlements with Aetna include $1M for issuing unapproved disability and life insurance policies in Washington state and $1M for failing to cover certain services as advertised in Massachusetts, FierceHealthPayer previously reported.
Aetna fined $1 million for Medicare Part D in-network mishap
Aetna fined $1M for issuing unapproved disability, life insurance
Aetna fined $1M for not covering services, false advertising
Aetna fined $850K for inadequate benefit disclosures