The Pa. Insurance Department (PID) announced Tuesday a market conduct exam on Aetna found several violations that negatively impacted policyholders.
HARRISBURG, Pa. — Health care company Aetna was fined $550,000 by the Pennsylvania Insurance Department (PID) on Tuesday following the results of a market conduct exam, the Shapiro Administration announced.
The exam conducted by the PID on Aetna found several violations by the company that negatively impacted policyholders. These exams hold insurance companies accountable to ensure Pennsylvania families receive the coverage they are promised, the administration said.
“A few years ago, Governor Shapiro tasked PID with making mental health parity a true reality for Pennsylvanians,” said Pa. Insurance Commissioner Michael Humphreys.
“Today’s announcement is another giant step toward that ultimate goal and represents just one of the many ways PID protects consumers. Our front-end compliance reviews and back-end enforcement is among the most robust in the country, and we will continue to enforce Pennsylvania laws and regulations to the fullest extent of our statutory authority,” Humphreys continued.
The exam covered the period from Oct. 1, 2021, through Dec. 31, 2022, and a consent order was signed in January 2026.
According to the Shapiro Administration, PID’s exam found Aetna had incomplete claims files for autism spectrum disorder services (ASD), delays in approving or denying claims, improper claim denials due to poor communication about prior approvals and other insurance coverage and additional violations surrounding mental health parity laws.
The PID also found broader violations such as flawed methods for reviewing health parity compliance and failure to clearly list cost-sharing for ASD services in most plans.
Under the January 2026 Consent Order, Aetna must pay members what they are owed — with interest — and fix internal systems to avoid future claims issues. The company must also reprocess claims that were handled incorrectly and that did not meet mental health parity requirements.
The PID stated Aetna will have to fix denial letters and clearly explain why services were denied, especially for Applied Behavior Analysis for ASD.
Aetna has 12 months to complete the actions within the Consent Order and provide the PID regular reports.
The full report can be found on PID’s website.