Department of Banking and Insurance (DOBI)

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.

Out-of-Network Fees Proposed Regulations Changes

As the comment period closes on May 2, 2007, MSNJ sent DOBI our comments on the proposed amendments to the out-of network fees regulation. [click here to read the 17-pages of comments.]

Web Site Links:
New Jersey’s Department of Banking & Insurance
Doctor’s Corner

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