The insurance company Aetna agreed to pay $75,000 and take steps to make it easier for members to access behavioral health care, under a settlement reached with Massachusetts Attorney General Maura Healey.
“Massachusetts patients face far too many barriers to receiving essential mental health and substance use treatment,” Healey said in a statement. “With these commitments, Aetna is making it easier for patients to access the care they need.”
Healey’s office alleged that Aetna violated the state’s consumer protection law by publishing directories of providers that were “materially inaccurate and deceptive.”
Aetna’s online provider directories are supposed to give health care consumers a way to find a health care provider that is in Aetna’s network and accepting new patients. Healey’s office said those directories were at times inaccurate — they did not correctly reflect when a doctor was accepting new patients or they provided incorrect contact information or locations.
Healey’s office also charged that Aetna was unfairly denying treatment for substance use disorder, despite a state law that requires insurers to cover addiction treatment for up to two weeks without preauthorization.
Under the terms of the agreement, filed in Suffolk Superior Court on Tuesday, Aetna agreed to regularly update its provider directories. Aetna said it would create a way for members and doctors to easily report incorrect information, and would quickly act to verify the information and update its directories.
Aetna will be required to maintain a behavioral health network that is “adequate in numbers and types” of providers. The provider directory for these clinicians will have to contain specific information and be regularly reviewed for accuracy.
Aetna will be required to clearly disclose what types of behavioral services require prior authorization and to inform members that routine behavioral health care visits do not need prior authorization. In the area of substance abuse care, Aetna said it will comply with the state law requiring it to cover up to 14 days of medically necessary treatment for addiction without preauthorization.
The $75,000 settlement paid to the state includes a $25,000 civil penalty and $50,000 in attorneys’ fees.
The settlement was submitted to the court the same day the Blue Cross Blue Shield of Massachusetts Foundation released a report showing that Massachusetts adults struggle to access care for mental health problems and substance use disorders.
“It’s frustrating for families who need these services to hit roadblocks and have to jump through hoops to get care,” said Joanne Peterson, founder and executive director of Learn to Cope, which offers resources to family members of people struggling with addiction, in a statement. “Our battle against the opioid epidemic starts with making treatment accessible to those in need.”
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