The Pennsylvania Insurance Department fined Aetna $190,000 Jan. 8 over concerns about its coverage for autism spectrum and substance use disorders.
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.
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