The Pennsylvania Department of Insurance fined health insurer Aetna Inc. $190,000 for violating rules on coverage of drug and alcohol abuse treatment and coverage of autism spectrum disorder, the agency said Tuesday.
The fine was the result of the state regulatory agency’s review of the insurer’s operations in Pennsylvania between January 2015 and March 2016. The review also found that Aetna was not complying with the federal Mental Health Parity and Addiction Equity Act.
In the area of substance use disorders, the department found “confusing policy language which could have led consumers to inaccurately believe they did not have coverage for certain substance use disorder services,” according to a statement issued by the state agency.
“Making sure Pennsylvanians receive the substance use disorder benefits to which they are entitled under their health insurance coverage is a key part of Gov. Wolf’s battle against the opioid crisis,” Insurance Commissioner Jessica Altman said.
Specific violations included incorrect application of copays, coinsurance, and visit limits, as well as violations involving prior authorization for treatment and step therapy, the department said. The regulator said it had recovered more than $20,000 in restitution for consumers. The department has similar examinations of other insurers in the works.