Attorney General Martha Coakley Reaches Settlement With Health Insurer That Failed To Provide Mandated Benefits, Massachusetts

Main Category: Litigation / Medical Malpractice
Also Included In: Health Insurance / Medical Insurance
Article Date: 30 Jan 2009 - 2:00 PDT

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Attorney General Martha Coakley's Office entered into a settlement with Aetna Health Inc., resolving claims the insurer failed to provide health benefits required by Massachusetts law. The Assurance of Discontinuance, entered today in Suffolk Superior Court, alleges that Aetna committed unfair or deceptive acts when it sold health insurance policies that violated Massachusetts' mandated benefits laws. The Assurance alleges Aetna denied coverage for infertility in certain circumstances in violation of Massachusetts law by improperly excluding benefits for egg procurement and processing services and by denying such services. Under the terms of the agreement, Aetna will pay $10,000 to the Attorney General's Local Consumer Aid Fund, review all denials of consumer claims and requests for the wrongfully excluded infertility treatment, and approve all requests and claims for such treatment that were wrongfully denied to consumers.

"This case comes about as a result of a comprehensive, market-wide review of non-compliance with Massachusetts mandated benefits laws," said Attorney General Martha Coakley. "Consumers deserve to get what they are paying for and to feel confident that insurers will comply with state laws relating to required benefits."

The Attorney General's Office previously settled similar issues with ten other health insurers, Fallon Community Health Plan, GenWorth Life and Health Insurance Company, Harvard Pilgrim Health Care, John Alden Life Insurance Company, New England Life Insurance Company, UniCare Health and Life Insurance Company, Time Insurance Company, Union Security Insurance Company, The Guardian Life Insurance Company and Pan-American Life Insurance Company. The Attorney General also has a suit pending that relates, in part, to these issues against The Mega Life and Health Insurance Company, Mid-West National Life Insurance Company of Tennessee and HealthMarkets, Inc.

Massachusetts law requires insurance companies that sell health insurance in the state to provide certain benefits, including infertility treatment.

Consumers concerned about illegal health insurance practices in the Commonwealth are urged to call the Attorney General's Health Care Hotline at (888) 830-6277. Consumers who wish to purchase health insurance can find a number of available options at http://www.mahealthconnector.org.

This matter was handled by Assistant Attorney General Emiliano Mazlen and Division Chief Quentin Palfrey of Attorney General Coakley's Health Care Division.

Source
Jill Butterworth
Deputy Press Secretary
Office of Attorney General Martha Coakley
Office - (617) 727-2200 ext. 2601
http://www.mass.gov/ago

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