Pennsylvania Insurance Department has fined Aetna $550,000 and ordered the carrier to repay affected policyholders with interest following findings of mental health parity violations.
A market conduct examination identified multiple compliance failures.
Regulators cited incomplete claims files for Autism Spectrum Disorder services, delays in approving claims, deficiencies in reviewing parity compliance and failure to clearly disclose cost-sharing requirements for ASD services across most plans.
The department concluded these practices negatively affected Pennsylvania members. In addition to the monetary penalty, Aetna must strengthen internal processes to ensure timely and complete claims handling. Most corrective actions must be completed within 12 months.
Michael Humphreys said enforcement of mental health parity remains a priority, referencing directives to ensure coverage for behavioral health services aligns with statutory standards.
According to Beinsure analysts, parity enforcement actions often hinge on documentation practices and disclosure transparency rather than outright benefit exclusions.
Administrative gaps, particularly in autism-related services, frequently trigger regulatory scrutiny.
The department stated it will continue front-end compliance reviews and enforcement measures to uphold state insurance laws and consumer protections.
