Mass. AG Enters Into Settlement with Aetna

Massachusetts Attorney General Martha Coakley’s Office has 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 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.

The Attorney General’s Office previously settled similar issues with 10 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.