Delaware regulators fine insurers Highmark, Aetna for late claims payments

Wes Venteicher
| Monday, Jan. 11, 2016, 11:00 p.m.

Highmark Inc. and Aetna Inc. were fined by Delaware insurance regulators for failing to pay policyholders' claims quickly enough and other violations.

The fines — $383,000 for Highmark and $100,000 for Aetna — resulted from violations that were discovered during routine examinations, the Delaware Insurance Department announced Monday.

Between Sept. 1, 2013, and September 30, 2014, Highmark failed to “either pay, deny or provide in writing a reason for the inability to pay a claim within 30 days,” according to insurance regulators. Highmark also failed to maintain records of complaints and failed to respond to the department's inquiries in a timely manner, the agency found.

At that time, Delaware's Blue Cross and Blue Shield plan was in the process of affiliating with Highmark, which required converting computer systems, Highmark Delaware spokesman Matthew Stehl wrote in an email. The period also covered the rollout of the Affordable Care Act, Stehl said.

“We were aware of the issues identified in the examination and worked closely with the provider community and our customers to resolve them,” he said in a statement.

Most of Aetna's violations occurred primarily between Jan. 1, 2010, and June 30, 2012, according to documents the department filed. Aetna failed to pay claims within 30 days, charged excessive fees for chiropractic appointments and committed other violations, according to documents.

“Aetna will continue to work closely with Commissioner (Karen Weldin) Stewart, and we welcome her attention to the need for compliance. We have reprocessed the claims for the providers involved,” said Aetna spokesman Walter Cherniak Jr.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or wventeicher@tribweb.com.

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