The state’s Department of Financial Services claimed Aetna failed to acknowledge and respond to members’ complaints within required time frames. The department also said Aetna failed to make preauthorizations. The health insurer agreed to pay a $1.95 million civil penalty to resolve the allegations.
Oscar agreed to pay $576,950 to resolve allegations it failed to follow utilization review deadlines. The department also said Oscar failed to include detailed explanations of denials.
To view Aetna’s full consent order, click here. To view Oscar’s, click here.
More articles on payers:
CMS’ final rule on risk adjustment payments: 3 things to know
BCBS of Wyoming customers overcharged due to banking error
ACA plan enrollment falls 11%: 3 things to know
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.