Delaware Commissioner Fines Highmark, Aetna $483K

January 12, 2016

Delaware Insurance Commissioner Karen Weldin Stewart announced she has fined Highmark Blue Cross Blue Shield Delaware $383,000 for violations, including failure to pay health insurance policyholder claims in a timely fashion.

Regulators said that from September 2013 to September 2014, in more than 230 instances, Highmark failed to either pay, deny, or to provide a reason for the inability to pay a claim in writing within 30 days after receipt of a clean claim.

Highmark also failed to issue a response within 15 working days in regard to the insured’s communication on a claim for 26 claims-related communications.

Stewart said she also fined Aetna Inc. $100,000 for failing to pay policyholder claims in a timely fashion and for charging excessive copays and other violations found during the examination period of January 2010 through June 2012.

Regulators found that in 29 cases, Aetna failed to implement prompt investigation of claims arising under insurance policies within 10 working days upon receipt of the notice of loss by the insurer. In 25 cases, Aetna also failed to pay the total allowed amount of the clean claim within 30 days of receipt.

The fines resulted from routine market conduct examinations of each insurer performed by Delaware Insurance Department examiners.


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