Aetna Fined Over Autism And Substance Abuse Coverage

State regulators in Pennsylvania fined health insurer Aetna  this week, for violating rules on coverage of drug and alcohol abuse treatment and coverage of autism spectrum disorder.

A federal law called the Mental Health Parity and Addiction Equity Act generally forbids health carriers from discriminating against coverage for mental health conditions or substance abuse disorders.  These laws are important because health insurers are often incentivized to deny coverage for mental health and substance abuse conditions, as they often require costly inpatient therapy.  Fighting such denials is hard because unlike conditions like a broken bone or the flu, mental health and addiction disorders can be harder to objectively document. Many states have similar rules.

Pennsylvania regulators found Aetna violated these rules.  The state identified “confusing policy language which could have led consumers to inaccurately believe they did not have coverage for certain substance use disorder services.”

Aetna also imposed improper copays, coinsurance, and visit limits, as well as illegally requiring prior authorization for treatment.

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