Aetna, Humana settle fines for information breach, coverage gaps

Two major healthcare insurers, Aetna and Humana, are set to dole out hundreds of thousands of dollars to settle separate disputes over health information disclosures and inadequate network coverage.

In New Jersey, Aetna, the nation’s third largest health insurance provider, has agreed to pay a $365,000 fine for violating the privacy of thousands of policyholders in two separate mailings, the Associated Press reported.

Aetna reportedly revealed the HIV status of 12,000 patients in several states in 2017, including more than 600 in New Jersey. The company mailed to policyholders information on how to purchase HIV medication in envelopes with a clear window that made the sensitive information visible. Aetna settled a lawsuit over the breach of information for $17 million in January.

In September this year, the company sent a mailing to 1,600 people in envelopes that stated the name and logo of a study for a heart condition. The action affected more than 180 people living in New Jersey. Aetna told the AP it is implementing new measures to prevent similar information breaches.

The settlement comes just as Aetna is preparing to merge with CVS Health in a $69 billion that was approved by the Department of Justice last week.

Separately, Humana will pay $700,000 to the Texas Department of Insurance for providing inadequate coverage in Harris, Bexar and Travis counties, according to the agency. Consumers couldn’t receive in-network coverage for anesthesia services at more than 20 hospitals and surgical centers in three of the state’s largest metro areas due to an inadequate number of anesthesiologists.

Humana was contacted by TDI after canceling network contracts for anesthesiology services, and the company agreed to take immediate corrective actions to reprocess bill so consumers did not face higher costs as a result of inadequate networks.

Health plans operating in Texas are required to file annual network adequacy reports with the agency and notify TDI and consumers about any coverage gaps. Humana’s reports to TDI did not adequately or timely disclose the issue to the agency or consumers, according to TDI.