By comparison, Kaiser got off lightly as this was over 3 times the amount of the fine...and ordered 12% interest on the unpaid claims...BD

NEWARK — New Jersey insurance regulators have fined Aetna Health Inc. nearly $9.5 million, charging that it failed to properly cover some services by out-of-network providers. 

The fine, announced Wednesday after being filed Monday, came after the state Department of Banking and Insurance received complaints following a letter issued in June by Aetna to health care providers.

In the letter, Aetna said providers outside its network would be reimbursed for services at 125 percent of the allowable Medicare amount, and 75 percent for lab fees and durable medical equipment.

Insurance Department Commissioner Steven M. Goldman ordered Aetna to halt its limited reimbursement practice and reprocess all claims for services rendered by nonparticipating providers hurt by Aetna's practices.  He ordered the company to pay providers based on the billed amount plus 12 percent interest from the date the claim was initially paid.


APP.COM - N.J. fines Aetna, saying it didn't cover services | Asbury Park Press Online


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