Pennsylvania insurance regulators fined CVS Health’s Aetna health insurance subsidiary $550,000 for violating rules meant to ensure that mental health services are as accessible as medical or surgical care, the state Insurance Department said Tuesday.
Regulators found that Aetna applied standards of review for certain autism therapies and inpatient opioid addiction treatment services that were more stringent than those applied broadly to medical claims submitted to the insurer. The result was limits on the scope and duration of the treatments that violated parity rules.
The department said Aetna would have to fix its practices within a year and repay affected customers. It did not specify how much money Aetna needs to repay, or how that process would work.
“Aetna has long been an advocate of the Mental Health Parity and Addiction Equity Act. Aetna has received the results of the market conduct exam from the Pennsylvania Insurance Department and will implement, as appropriate, any corrective actions,” the company said in an email.
The violations were found during a regular periodic review of insurers’ practices. The Aetna exam covered the period from October 2021 through Dec. 2022. Aetna and regulators signed a consent order in January.
The insurance department fined Aetna $190,000 in 2019 for similar violations of the Mental Health Parity and Addiction Equity Act, a federal law passed in 2008.