Missouri fines Aetna for paying for uninsured abortions

AP News
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Posted: May 19, 2015 8:04 PM

JEFFERSON CITY, Mo. (AP) — Missouri Gov. Jay Nixon announced Tuesday that insurer Aetna has agreed to pay $4.5 million for violations of state law that included paying for elective abortions when the women were not eligible under their policies, marking the largest insurance penalty in state history.

In documents outlining the agreement, the insurance company said it covered elective abortions for women who did not pay for additional insurance for those abortions. A 1983 Missouri law requires that women buy optional insurance for elective abortion coverage.

Aetna also reported that it violated a 2010 law mandating certain treatments for autism be paid for.

Spokesman Rohan Hutchings said the company notified members that the autism insurance was optional, but did not require members accept or deny the additional coverage. Hutchings said Aetna is reviewing claims of those potentially affected, which he said do not include individuals on Medicare and Medicaid, and will pay for claims that were incorrectly denied at 9 percent interest.

Hutchings said the company "takes responsibility," and that "when we make mistakes, we do take steps to correct our errors."

Aetna now covers autism treatments in all policies, Hutchings said, and claims for abortions undergo additional vetting.

The settlement follows a $1.5 million fine against the company in 2012 for similar claims that it violated state laws on health coverage of autism and abortions, as well as contraceptives.

Since then, Aetna reported providing nine elective abortions to women without additional insurance riders despite agreeing in the 2012 settlement to comply with those laws. The company also failed to fully audit its compliance of state insurance laws, which it said meant Aetna continued to violate state mandated coverage for autism treatments.

"This agreement demonstrates that we will hold Aetna or any other insurance company responsible to the people of this state - particularly children with autism disorders - to provide the coverage the law requires," Nixon said while announcing the agreement at an autism center in Springfield.

Aetna faces a three-year monitoring period as part of the new settlement. The Department of Insurance can stop Aetna from conducting business in Missouri for as long as a year if the company continues to violate state laws outlined in earlier agreements.

The department will waive $1.5 million of the $4.5 million fee if Aetna complies with state law and other stipulations in that period.

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