Mike Kreidler, the Washington state insurance commissioner, imposed $65,000 in fines on a health insurer in collection with allegations that the insurer denied 220 acupuncture claims in an unreasonable fashion.
Kreidler imposed the fines on Aetna Life Insurance Company, a unit of Aetna Inc., Hartford (NYSE:AET).
The company also has refunded $16,247 to policyholders, officials say.
Officials asked Aetna Life to review acupuncture claim complaints for the period from April 1, 2010, to June 30, 2010. When Aetna Life found no evidence of acupuncture claim problems during that period, officials asked it to conduct a review of acupuncture claims filed from July 1, 2008, to June 30, 2010.
Aetna Life found that 220, or about 13%, of the 1,761 claims reviewed were denied based solely on the diagnosis code of the claim.
Aetna Life could not justify the denials based on cost-effectiveness or clinical efficacy, officials say.
Aetna Life has consented to the entry of the order and has waived rights to challenge the order or have a hearing, officials say.
Representatives from Aetna were not immediately available to comment on the fines.
- Allison Bell