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.