In Brief: DMHC Fines Aetna $182,500

The Department of Managed Health Care has fined Aetna Health of California $182,500 for 41 instances where the insurer failed to appropriately handle enrollee grievances.

            According to correspondence from the DMHC, Aetna did not respond to requests for information from the regulator in a timely fashion; failed to adequately consider enrollee grievances; failed to provide all of the information for the resolution of a dispute; failed to resolve enrollee grievances within 30 days; and failure to provide written acknowledgement of a grievance in a timely fashion, among others. The 20 fines levied for the violations range in size from $2,500 to $20,000. The correspondence did not note when the violations occurred.

            Aetna has agreed to a corrective action plan that includes additional training for staff that handles enrollee grievances and appeals. It indicated to the DMHC that its current policies for handling enrollee grievances and appeals do not need to be amended.