For Immediate Release - January 04, 2010

Attorney General Martha Coakley's Office Reaches Settlement with Health Insurer that Failed to Provide Mandated Benefits

BOSTON - Attorney General Martha Coakley's Office filed a consent judgment in Suffolk Superior Court, resolving allegations that Continental American Insurance Company failed to provide health benefits to its customers that were required by Massachusetts law. The Attorney General's Office alleged that Continental American committed unfair or deceptive acts when it marketed and sold health insurance policies that violated Massachusetts' mandated benefit laws. The complaint also alleges Continental marketed its plans in a manner which suggested that they provided more coverage than they actually did. Under the terms of the agreement, Continental American will pay $25,000 to the Attorney General's Local Consumer Aid Fund, review all denials of consumer claims for the wrongfully excluded services, and approve all claims for services that were wrongfully denied to consumers.

"Choosing a health care provider can be overwhelming and when an insurance company misrepresents what the plan provides, they only exacerbate the issue," said Attorney General Coakley. "Our office will continue to monitor the marketing and advertising practices of health care companies in Massachusetts to ensure that consumers get accurate information and the benefits that they are entitled to under the law."

The Attorney General's complaint, filed in Suffolk Superior Court on December 22, 2009, alleges that Continental American failed to cover preexisting conditions properly and failed to cover a number of mandated benefits, including mental health services; preventive care for children under age six; prenatal, childbirth and postpartum services; cytologic screening and mammograms; infertility treatment and treatment for alcoholism.

The Attorney General's Office previously settled similar issues with other health insurers, most recently, The Mega Life and Health Insurance Company, Mid-West National Life Insurance Company of Tennessee and HealthMarkets, Inc. During the past three years, the Attorney General's Office has also resolved mandated benefit matters with Aetna Health Inc., Time Insurance Company, Union Security Insurance Company, The Guardian Life Insurance Company and Pan-American Life Insurance Company.

Consumers concerned about unfair health insurance practices in the Commonwealth are urged to call the Attorney General's Health Care Hotline at (888) 830-6277. Consumers who wish to purchase health insurance can find a number of available options at www.mahealthconnector.org.

This matter was handled by Assistant Attorneys General Emily Paradise and Emiliano Mazlen and Division Chief Tom O'Brien of Attorney General Coakley's Health Care Division.

##########