- Office of Attorney General Maura Healey
Media Contact for Aetna Agrees to Make Substantial Improvements to Behavioral Health Care Access
Boston — Aetna Health Insurance Company and two affiliated companies have reached an agreement with the Attorney General’s Office to undertake substantial measures that will help their Massachusetts members access behavioral health services, Attorney General Maura Healey announced today.
This settlement, part of the AG’s Office’s ongoing work to address behavioral health parity and improve access to behavioral health care, resolves the AG’s investigation into concerns that Aetna’s online directories mislead patients and that Aetna has not fully complied with state laws requiring insurers to cover certain substance use disorder treatment without prior authorization.
“Massachusetts patients face far too many barriers to receiving essential mental health and substance use treatment,” said Attorney General Maura Healey. “With these commitments, Aetna is making it easier for patients to access the care they need.”
Under the terms of the assurance of discontinuance (AOD), filed yesterday in Suffolk Superior Court, Aetna has agreed to improve the accuracy of information in its provider directories and undertake measures to allow its members to more easily identify and access behavioral health care providers. These measures include regular provider directory audits; timely correction of inaccurate information in the provider directory, including information identifying providers’ availability to see new patients; and the tracking and resolution of members’ complaints concerning directory inaccuracies and network provider adequacy.
“Our goal at the Grayken Center is to ensure people get the treatment and support they need and are entitled to in order to achieve recovery,” said Michael Botticelli, Executive Director of the Grayken Center for Addiction Medicine. “I thank the Attorney General’s Office and Aetna for making this important step towards true parity and the access our families need.”
“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. “Our battle against the opioid epidemic starts with making treatment accessible to those in need. I applaud Aetna for making these important commitments to behavioral health parity.”
Several national studies have shown the problems with health insurance companies’ provider directories. A report from the U.S. Department of Health and Human Services released last month found that nearly 50 percent of provider directories for Medicare Advantage plans displayed missing or inaccurate information, including claims that providers were accepting new patients when they were not. A separate report released yesterday by the Blue Cross Blue Shield of Massachusetts Foundation found 38.7 percent of those surveyed went without needed behavioral health treatment in the last year and that for most patients who had difficulty accessing behavioral health care, the problem was that providers either did not accept their insurance or their practices were closed to new patients.
Under this settlement, Aetna will take concrete steps to address these problems with its directories in Massachusetts so that members will know which behavioral health providers are available to them and where there are gaps in available care.
The AOD separately requires Aetna to disclose to its members that it does not require prior authorization, or pre-approval, before routine behavioral health visits, and to disclose to members any circumstances where it does require prior authorization for behavioral health services. This commitment ensures that members do not face unnecessary barriers to accessing needed care. The AG’s assurance of discontinuance also ensures that Aetna will keep records to allow for monitoring of its further compliance with the parity laws.
The AOD also requires that Aetna comply with the provisions of Chapter 258 of the Acts of 2014 that require coverage for 14 days of detoxification treatment for substance use disorder without preauthorization. The coverage requirement applies even if the provider is out of state.
Aetna will pay $75,000 to the Commonwealth, including a $25,000 civil penalty.
The investigation and settlement are part of the AG’s ongoing examination of barriers that Massachusetts residents face in accessing behavioral health care services. Such barriers include health care provider directories with inaccurate or incomplete information and insurance networks with inadequate numbers or types of behavioral health care providers.
Consumers who cannot find a behavioral health care provider in their insurer’s on-line directory should call their insurance company using the phone number listed here.
This matter was handled by Assistant Attorneys General Matthew Berge, Lisa Gaulin, Tara Ruttle, and Stephen Vogel, and Mediator Anna Everett, with assistance from Division Chief Eric Gold of the AG’s Health Care Division, and Investigator Marlee Greer of the Civil Investigations Division.