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Life Health > Health Insurance

Aetna Texas Units Agree To Pay Restitution And $1.5 Million Fine

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NU Online News Service, Nov. 2, 3:41 p.m. — The Texas Department of Insurance says four insurance companies and health maintenance organizations owned by Aetna Inc., Hartford, have agreed to pay restitution to doctors and other health care providers who have faced chronic payment delays.

The Aetna units have also agreed to pay $1.5 million in fines, the Texas department says.

Aetna agreed to the consent order requiring the restitution without admitting to any violation of Texas laws and rules, the Texas department says.

The consent order says the Aetna companies failed to pay clean claims in accordance with Texas’s prompt-payment laws and clean-claims rules; failed to pay 85% of disputed claims while conducting audits; and failed to maintain proper complaint records.

The Texas department announced similar allegations against seven other major medical carriers. The department required those carriers to pay restitution and a total of $9.25 million in fines.

The four Aetna companies and HMOs accused of prompt-payment law violations are Aetna Life Insurance, Aetna U.S. Health Care Inc., Aetna U.S. Health Care of North Texas Inc. and Prudential Health Care Plan Inc.

The Aetna companies must pay restitution to physicians and providers for clean claims that were not paid within 45 days of receipt, clean claims paid after the 45th day of receipt and clean claims that were not paid correctly, the Texas department says.

The order calls for each company to provide restitution to physician and health care providers for claims dating from Aug. 1, 2000, through Oct. 1, 2001, the Texas department says.

Aetna U.S. Healthcare of North Texas faces an additional fine of $600,000 if it fails to satisfy several voluntary payment arrangements for claims for the benefit of physicians and providers associated with Medical Select Management, which filed a bankruptcy petition July 23, the Texas department says.


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