JEFFERSON CITY, Mo. (CN) – Aetna Life and Health Insurance will pay up to $4.5 million to settle claims they failed to cover diagnosis and treatment of autism spectrum disorders.
Gov. Jay Nixon announced the settlement Tuesday, which includes the state’s largest fine ever for insurance law violations.
The settlement allows the Missouri Department of Insurance to suspend Aetna from doing business in the state for up to a year if it violates the settlement during a three-year monitoring period.
Nixon, a Democrat, spearheaded a bipartisan effort in 2010 to pass a law mandating coverage of autism. The law for the first time required insurers to cover an effective autism therapy called Applied Behavioral Analysis.
The cost of Applied Behavioral Analysis can exceed tens of thousands of dollars a year, making insurance coverage a must for most families.
In the settlement, Aetna admitted that it failed to offer autism coverage in some cases. It will pay the $4.5 million fine and must take corrective action and submit to three years of monitoring by the Department of Insurance. If it complies with the settlement, $1.5 million of the fine will be suspended.
“The landmark law requiring insurance companies to cover autism spectrum disorders was a great victory for many thousands of Missouri kids and their families,” Nixon said, in announcing the agreement at the Burrell Autism Center in Springfield. “This agreement demonstrates that we will hold Aetna or any other insurance company responsible to the people of this state – particularly children with autism disorders – to provide the coverage the law requires.”
Aetna also admitted it violated the autism mandate in 2012 and paid a $1.5 million fine under a settlement agreement, which required it to undertake a full and complete audit to ensure compliance. Aetna admitted it did not perform the full compliance audit.
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