Aetna, United Healthcare To Reexamine Seven Years of Denied Claims in Response to New York Insurance Department Report

Health insurers Aetna U.S. Healthcare and United Healthcare have decided to reexamine claims denied between mid-1994 and late 2001, after a New York Department of Insurance report found that they did not inform members about the appeals process for denied claims, the Newsday/Hartford Courant reports. In a market conduct examination, the department found that between mid-1994 and mid-2001, Aetna did not include "any information" about the appeals process in explanations included with claim denials, and United Healthcare only "referred members to their handbooks." The department also cited Aetna for "serious inadequacies" in the company's claims processing system. The department fined Aetna $1.5 million and United Healthcare $1 million, according to department spokesperson Joanna Rose. According to a statement, "Aetna takes seriously the findings of the New York Department of Insurance, and wants to emphasize ... the company has initiated a number of steps and system enhancements that address many of the issues raised in the reports." Aetna will reexamine some claims denied between Jan. 1, 2000, and Sept. 30, 2001, and United Healthcare will allow appeals of claims submitted between July 1994 and December 2001 for "policy holders who have not pursued previous appeals," Rose said. The insurers have published advertisements in area newspapers to inform members (Newsday/Hartford Courant, 7/9).