Charges have been imposed because acupuncture benefits were unfairly denied by Aetna, a health insurance company. The Washington State Office of Insurance Commissioner (OIC) fined Aetna Life Insurance, Co. of Hartford, Connecticut a total of $65,000 for failing to pay for medically necessary acupuncture benefits on 220 health insurance claims. Aetna was also ordered to refund health insurance policy-holders a total of $16,427.64 for refusing to pay for acupuncture services that were included in their policy packages.
The investigation began when the Washington OIC requested an internal audit of acupuncture payments by Aetna. Initially, Aetna responded by saying that only two health insurance claims were wrongfully denied. Aetna proposed corrective action for the two claims and for untimely processing of other claims. This was accepted by the Washington OIC but the investigation remained open. A secondary acupuncture benefits audit was conducted by Aetna and the company denied any further wrongdoing. The Washington OIC responded with a request for yet another audit at which time Aetna admitted that 220 acupuncture health insurance claims were unfairly denied. Of 1,761 acupuncture claims that were investigated, it was found that 12.6% were in violation of Washington State regulation RCW 48.30.010. This regulation states that “no person engaged in the business of insurance shall engage in unfair methods of competition or in unfair or deceptive acts or practices in the conduct of such business as such methods, acts, or practices.”
Aetna officials have waived the right to a hearing and have waived the right to challenge the ruling by the Washington State Insurance Commissioner, Mike Kreidler. Aetna could not present a justification for the denial of the health insurance coverage as promised to its customers in their benefits packages. The Aetna Regulatory Compliance Manager signed the agreement with the Washington OIC and is in the process of making reparations for wrongful denial of acupuncture claims.
