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.
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