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Aetna, Oscar fined in NY for missing required deadlines

The New York State Department of Financial Services fined Aetna and Oscar Insurance Co. more than $2.5 million combined for missing required deadlines to consumers.

Aetna Health Inc., Aetna Health Insurance Co. of New York and Aetna Life Insurance Co. will pay $1.95 million for failing to make prospective determinations, including pre-authorizations, and failing to acknowledge and respond to members within required time frames, among other missed deadlines. The DFS said that between 2012 and 2015, Aetna failed to meet a number of timelines related to grievances and appeal determinations, as well as inappropriately denying claims and applying cost sharing to certain preventive care services.

Oscar will pay a $576,950 fine for, between 2013 and 2015, not meeting deadlines for utilization reviews, not including explanations of adverse determination notices and not including forfeiture language in benefit statements.

The insurers agreed to review and revise their procedures, among other corrective actions.