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Aetna Health Settles with Mass. A.G. Over Infertility Treatments

by Fran Matso Lysiak,  Best Week,  Feb 2, 2009

The Massachusetts attorney general's office said it reached a settlement with Aetna Health Inc. that resolves claims that the health insurer in some circumstances denied coverage for infertility treatment in violation of the state''s mandated benefits laws.

Aetna Health will pay $10,000 to Attorney General Martha Coakley''s Local Consumer Aid Fund, review all denials of claims and requests for excluded infertility treatment and approve requests and claims for the treatment that were wrongfully denied, according to a statement from the attorney general''s office.

According to the settlement agreement, reached in Suffolk Superior Court, Aetna Health allegedly committed unfair or deceptive acts when it sold health insurance policies that violated Massachusetts' mandated benefits laws by improperly excluding and denying benefits for egg procurement and processing services.

An Aetna spokesperson said that based on the company's review of claim files, the company denied preauthorization of the services to one member and in response to the attorney general's inquiry, Aetna extended the benefits to that member. Aetna is complying with the mandate as specified with the attorney general, the spokesperson said.

Massachusetts law requires insurance companies that sell insurance in the state to provide certain benefits, including infertility treatment, the attorney general's office said.

Generally, health insurers consistently oppose legislative mandates for specific health care services, from contraceptives to testing for uterine cancer, as being costly to policyholders.

Coakley's office said it settled similar issues with other health insurers. These include Harvard Pilgrim Health Care, John Alden Life Insurance Co. and Guardian Life Insurance Co. A suit is pending against Mega Life and Health Insurance Co., Mid-West National Life Insurance Co. of Tennessee and HealthMarkets Inc., which relates partly to these issues, the attorney general''s office said.

Aetna Health companies currently have Best Financial Strength Ratings ranging from A to A- (Excellent).


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