Harrisburg, PA – Aetna will pay $550,000 to the Commonwealth of Pennsylvania and overhaul its practices following a market conduct exam by the Pennsylvania Insurance Department (PID) that revealed multiple violations impacting policyholders, the PID announced Tuesday.
The exam, which covered the period from October 1, 2021, through December 31, 2022, found Aetna had incomplete claims files for services related to autism spectrum disorder (ASD), caused delays in approving or denying claims, and improperly denied claims due to communication failures regarding prior authorizations and coverage details. The findings also included broader violations related to methods for reviewing health parity compliance and a failure to clearly list cost-sharing for ASD services in many plans, according to the Shapiro Administration.
Pennsylvania Insurance Commissioner Michael Humphreys stated the action represents a significant step toward achieving mental health parity for Pennsylvanians, a goal Governor Shapiro set for the PID several years ago. “Our front-end compliance reviews and back-end enforcement is among the most robust in the country, and we will continue to enforce Pennsylvania laws and regulations to the fullest extent of our statutory authority,” Humphreys said.
A Consent Order outlining the required corrective actions was signed in January 2026. Under the order, Aetna is required to repay affected Pennsylvanians the amounts they are owed, with interest, in addition to the $550,000 penalty. The company must also fix internal systems to prevent future violations.
The PID’s market conduct exams are a key component of the Shapiro Administration’s consumer protection efforts, holding insurance companies accountable and ensuring families receive the coverage promised, according to the department. The exam findings specifically highlighted issues with Aetna’s handling of claims for autism spectrum disorder services, indicating systemic problems in processing and adjudicating these claims.
