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Aetna fined for parity violations in Pennsylvania
Author(s) -
Knopf Alison
Publication year - 2019
Publication title -
alcoholism and drug abuse weekly
Language(s) - English
Resource type - Journals
eISSN - 1556-7591
pISSN - 1042-1394
DOI - 10.1002/adaw.32240
Subject(s) - equity (law) , mental health , authorization , prior authorization , substance abuse , medicine , actuarial science , business , psychiatry , law , political science , computer security , nursing , computer science
This month, Aetna was fined $190,000 for not complying with the federal Mental Health Parity and Addiction Equity Act. Specifically, the health insurer did not cover substance use disorder (SUD) and autism spectrum disorder as it was required to, according to a review by the Pennsylvania Department of Insurance. Aetna used “confusing policy language which could have led consumers to inaccurately believe they did not have coverage for certain substance use disorder services,” according to the insurance department. “While the department reviewed many priority areas through this examination, a significant focus was on the company's compliance with laws requiring parity of coverage for substance use disorders and mental health, which must be offered at the same level of benefits as medical or surgical treatment,” Pennsylvania Insurance Commissioner Jessica Altman said in a statement. She added, “Violations included incorrect application of copays, coinsurance and visit limits, as well as violations involving prior authorization for treatment and step therapy.”