(Bloomberg) — Aetna Inc. is paying a record $4.5 million fine in Missouri in part for something that rarely draws the ire of regulators — paying for procedures it shouldn't have covered.
In this case, those procedures were abortions. Missouri law says health insurers shouldn't pay to help end a pregnancy unless a woman buys separate coverage.
While Missouri had imposed a similar fine in the past on Aetna, it's rare for state overseers to ding health plans for paying for too much, said Chris Koller, a former Rhode Island health insurance regulator.
"I have never heard of a company being penalized for covering more than was required," Koller said in an e-mail. He's now president of the Milbank Memorial Fund, a nonpartisan group that works with health policy makers. "But it had happened before with them."
Missouri's law dates to the early 1980s, but the controversy over insurers' coverage of abortion gained wider attention in the debate over the 2010 Patient Protection and Affordable Care Act (PPACA), said Elizabeth Nash, who tracks states policies at the Guttmacher Institute. Under a deal worked out by lawmakers on that U.S. bill, states can restrict abortion coverage on their own insurance exchanges, and federal funds can't be used for the procedure unless the pregnancy endangers the woman's life or is the result of rape or incest.
Nine states other than Missouri have limits on abortion coverage by private insurers, according to Guttmacher. Additional states impose restrictions on plans sold on the PPACA exchanges and on Medicaid coverage of abortions.
Autism treatment
In addition to abortion coverage, the fine in Missouri penalized Aetna for not covering some treatments for autism. The insurer admitted to paying for nine abortions and to failing to offer the autism coverage.
Chris Cline, a spokesman for the state's insurance regulator, said the fine was for the full extent of Aetna's actions and can't be broken down to reflect how much the company was penalized for the abortion coverage alone.
