Insurance

DOBI Proposes Re-adoption of HMO Regulations
MSNJ’s Director of Government Affairs, Eileen Kean, Esq., has written a letter in response to the regulation’s proposed re-adoption.

DOBI Levies nearly $9.5 million in penalties against Aetna Health Inc. [July 25, 2007]

Summary of DOBI Order | Full Text of DOBI Order

On Monday, July 23, 2007, Commissioner Steven M. Goldman of the New Jersey Department of Banking & Insurance signed an order penalizing Aetna for its recent arbitrary payment decisions concerning out-of-network reimbursement under certain circumstances.

This is among the largest fine ever levied by DOBI against a healthcare insurer, and it sends a message to all other payors that they cannot act above the law or the power of the Commissioner’s jurisdiction. MSNJ believes that this order:

• Sends a message to insurers that DOBI will not accept their unilateral determination of “fair” reimbursement to out-of-network providers when that determination is contrary to its regulations;
• Sends a message to all stake-holders that DOBI will monitor payment practices to ensure good faith in claims processing; and
• Assures patients that DOBI will investigate and address attempts by healthcare insurers to shift the costs of medical care to them.