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Missouri Announces $4.5 Million Settlement with Aetna

Company failed to provide required coverage for diagnosis and treatment of autism spectrum disorders
May 19, 2015

SPRINGFIELD, Mo. – Governor Jay Nixon today announced that the State of Missouri has reached a $4.5 million settlement with Aetna Life Insurance Company and Aetna Health Insurance Company, which failed to provide the required coverage for diagnosis and treatment of autism spectrum disorders.

The settlement – which includes Missouri’s largest fine ever for insurance law violations -- allows the Missouri Department of Insurance to suspend the companies from doing business in the state for up to one year, if they violate the agreement during a three-year monitoring period.

 “The landmark law requiring insurance companies to cover autism spectrum disorders was a great victory for many thousands of Missouri kids and their families,” Gov. 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.”

In 2010, Gov. Nixon led a bi-partisan effort to pass the law mandating the coverage of autism diagnosis and treatment. For the first time, insurance companies were required to cover one of the most highly effective types of therapy, Applied Behavior Analysis, or ABA.  The cost of ABA can exceed tens of thousands of dollars a year, making insurance coverage necessary for most families.  

"Ever since the legislature led the way by passing a strong autism insurance mandate back in 2010, the state of Missouri has shown a remarkable commitment to enforcing that law for the benefit of families struggling with autism,” said Lorri Unumb, Autism Speaks’ vice president of state government affairs. “We commend Governor Nixon and Commissioner John Huff for their continuing leadership and willingness to do what's right for these families and ultimately for the state."

In today’s settlement, Aetna admitted it failed to offer autism coverage in some cases.  In addition to a $4.5 million fine, Aetna must undergo a corrective action plan and three years of monitoring by the Department of Insurance. A portion of the fine, $1.5 million, will be suspended if Aetna complies with the settlement agreement. Under the Missouri Constitution, civil fines go to the School Fund.

In 2012, the two Aetna companies also admitted to violating the autism mandate and paid a $1.5 million fine under a settlement agreement with the Department of Insurance. The companies were required to undertake a complete audit to ensure compliance with all Missouri insurance mandates. Aetna admits it did not undertake that full compliance audit.

 “These were serious violations that deserved serious punishment,” Governor Nixon said, “and that’s what Aetna received.”