According to a market conduct examination of the health insurer, the department found Aetna largely complied with insurance laws between January 2015 and March 2016. However, the department uncovered violations relating to autism coverage, in addition to confusing policy language that could have led members to think they didn’t have coverage for certain substance use disorder services.
“Violations included incorrect application of copays, coinsurance, and visit limits, as well as violations involving prior authorization for treatment and step therapy,” according to the department.
Aetna has addressed many of the violations found by the department through changes in company procedures and practices. The insurance department will verify the changes during a re-examination process.
More articles on payers:
Walmart is changing how we pay for healthcare: 5 things to know
Walmart, GM should be ‘wake-up call’ for private insurers
Health plan members are winning more appeals in Massachusetts
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
