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N.Y. insurance department fines Aetna $850,000 for disclosure failures

NEWS IN BRIEF — Posted Oct. 18, 2010

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Aetna has been fined $850,000 in New York, after a regulatory review that uncovered numerous failures by the insurer to make proper disclosures in its explanation of benefit forms.

Regulators reviewed records from March 1, 2001, through Dec. 31, 2005, and found that the company in some cases failed to delineate charges and claim payments clearly, failed to disclose members' right to appeal, failed to send notice of denied claims to physicians and hospitals, and failed to pay some claims promptly and pay interest on late payments.

In a stipulation agreement with the state department of insurance, Aetna admitted it broke the rules. It agreed to pay the fine and submit its plan for remedying the problems that were revealed by the state review.

"Almost all of the findings have been corrected." said Aetna spokeswoman Susan Millerick.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2010/10/18/bibf1018.htm.

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