State fines Aetna over autism, abortion coverage violations

Sep 26, 2012

The Missouri Department of Insurance has issued its largest penalty to date, to health insurance company, Aetna. 

The state’s insurance director, John Huff, says the $1.5 million settlement is the result of three main state law violations on Aetna’s behalf:

  1. The company excluded coverage of treatments for autism spectrum disorders, countering a state law passed in 2010;
  2. The company in some cases provided coverage for contraceptives without allowing employers to opt out of the coverage, violating a 2001 state law allowing employers and employees the right to exclude the coverage. If an employer excludes the coverage, an individual may directly opt in to the coverage;
  3. The company routinely provided coverage for elective abortions, which Missouri law forbids from being part of a standard health care policy (customers have to specifically request this type of coverage and then pay an extra premium for it.

“These are very personal laws, if you think about treatment for a child with autism and coverage for reproductive benefits,” says Huff. “So violations of these laws we consider to be very serious.”

Huff says Aetna will be putting $250,000 into a nonprofit focused on autism treatments and will be notifying customers that they can file claims for treatments that should have been covered.

Huff says the department’s investigations typically stem from customers filing complaints with the department. That wasn't the case with Aetna, however.

“There was some testimony in a legislative hearing related to problems an employer had with Aetna,” says Huff. “We picked up on that and started an investigation.”