Aetna Inc. () is an American
managed health care
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("ma ...
company that sells traditional and
consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through
Medicare. Since November 28, 2018, the company has been a subsidiary of
CVS Health
CVS Health Corporation (previously CVS Corporation and CVS Caremark Corporation) is an American healthcare company that owns CVS Pharmacy, a retail pharmacy chain; CVS Caremark, a pharmacy benefits manager; and Aetna, a health insurance prov ...
.
The company's network includes 22.1 million medical members, 12.7 million dental members, 13.1 million pharmacy benefit management services members, 1.2 million
health-care professionals, over 690,000
primary care
Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care t ...
doctors and specialists, and over 5,700 hospitals.
[
Aetna is descended from Aetna (Fire) Insurance Company of ]Hartford, Connecticut
Hartford is the capital city of the U.S. state of Connecticut. It was the seat of Hartford County until Connecticut disbanded county government in 1960. It is the core city in the Greater Hartford metropolitan area. Census estimates since the ...
. The name of the company is based on Mount Etna
Mount Etna, or simply Etna ( it, Etna or ; scn, Muncibbeḍḍu or ; la, Aetna; grc, Αἴτνα and ), is an active stratovolcano on the east coast of Sicily, Italy, in the Metropolitan City of Catania, between the cities of Messina a ...
, at the time the most active volcano in Europe.
History
1800s
* ''1819'': Henry Leavitt Ellsworth
Henry Leavitt Ellsworth (November 10, 1791 – December 27, 1858) was a Yale-educated attorney who became the first Commissioner of the U.S. Patent Office, where he encouraged innovation by inventors Samuel F.B. Morse and Samuel Colt. Ells ...
, Yale
Yale University is a private research university in New Haven, Connecticut. Established in 1701 as the Collegiate School, it is the third-oldest institution of higher education in the United States and among the most prestigious in the wor ...
graduate and attorney, became the second president of Aetna (Fire) Insurance Company, succeeding Thomas Kimberly Brace. Ellsworth, who later became the first U.S. Patent Commissioner, served as Aetna's president until 1821, when he resigned. He continued as a director at the company for another 16 years. Ellsworth's brother, William Wolcott Ellsworth
William Wolcott Ellsworth (November 10, 1791 – January 15, 1868) was a Yale-educated attorney who served as the 30th Governor of Connecticut, a three-term United States Congressman, a justice of the State Supreme Court.
Biography
Born in Wi ...
, also served as a director, as well as the company's first general counsel
A general counsel, also known as chief counsel or chief legal officer (CLO), is the chief in-house lawyer for a company or a governmental department.
In a company, the person holding the position typically reports directly to the CEO, and their ...
.
* On May 28, 1853, the Annuity department separated from Aetna Insurance to be incorporated as the Aetna Life Insurance Company, with Eliphalet Bulkeley as president.[ The fire insurance company went on to become part of Connecticut General, which merged into Cigna.
* On November 29, 1853, J. B. Bennett was appointed general agent of the company.
* ''1854:'' Aetna hired its first full-time employee, Thomas O. Enders, who later became president of the company.][
* ''1857:'' Aetna moved to new offices on Hungerford and Cone Streets in Hartford. The ]Panic of 1857
The Panic of 1857 was a financial panic in the United States caused by the declining international economy and over-expansion of the domestic economy. Because of the invention of the telegraph by Samuel F. Morse in 1844, the Panic of 1857 was ...
caused the closing of many businesses. Eliphalet Bulkeley blocked a move to liquidate the company during the economic downturn.[
* During the 1850s, The Aetna Insurance Company issued ]life insurance
Life insurance (or life assurance, especially in the Commonwealth of Nations) is a contract between an insurance policy holder and an insurer or assurer, where the insurer promises to pay a designated beneficiary a sum of money upon the death ...
policies on an undetermined number of African-American
African Americans (also referred to as Black Americans and Afro-Americans) are an Race and ethnicity in the United States, ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American ...
slaves
Slavery and enslavement are both the state and the condition of being a slave—someone forbidden to quit one's service for an enslaver, and who is treated by the enslaver as property. Slavery typically involves slaves being made to perf ...
, naming their owners as beneficiaries
A beneficiary (also, in trust law, '' cestui que use'') in the broadest sense is a natural person or other legal entity who receives money or other benefits from a benefactor. For example, the beneficiary of a life insurance policy is the perso ...
.
* ''1861:'' Aetna began offering life insurance policies which paid dividend
A dividend is a distribution of profits by a corporation to its shareholders. When a corporation earns a profit or surplus, it is able to pay a portion of the profit as a dividend to shareholders. Any amount not distributed is taken to be re-in ...
s to policyholders just as the mutual life insurance policies did. Aetna introduced its new service with higher commissions for its agents. Life insurance policy sales grew during the American Civil War
The American Civil War (April 12, 1861 – May 26, 1865; also known by other names) was a civil war in the United States. It was fought between the Union ("the North") and the Confederacy ("the South"), the latter formed by states th ...
.
* ''1864:'' By 1864, Aetna had increased its volume of business by 600% over 1861 and its annual premium income exceeded one million dollars.
*''1865:'' Due to the increased financial resources, by 1865 Aetna met the stringent regulatory requirements placed on life insurance companies in Massachusetts and New York and was authorized to begin soliciting business in these states.
* ''1867:'' Company income rose from $78,000 in 1861 to $5.129 million by 1867. Aetna moved to its third home office at 670 Main Street, Hartford.
* ''1868:'' Aetna altered its business practices, hiring its first actuary
An actuary is a business professional who deals with the measurement and management of risk and uncertainty. The name of the corresponding field is actuarial science. These risks can affect both sides of the balance sheet and require asset man ...
and abandoning the half-note premium system in favor of an all-cash premium plan.
* ''1872:'' Eliphalet A. Bulkeley died and Thomas O. Enders became president.
* ''1878:'' Aetna increased its capitalization from $150,000 to $750,000.[
* ''1879:'' Enders resigned as president and Eliphalet Bulkeley's son Morgan G. Bulkeley replaced him.]
* ''1888:'' Aetna purchased its fourth home office at 650 Main Street. It was the first building Aetna actually owned, and Aetna's home office for the next 42 years.[
* ''1891:'' Aetna issued its first accident policy to Morgan Bulkeley.
* ''1892:'' Aetna held its first general agents conference in Chicago.][
* ''1899:'' Aetna began offering health insurance policies.
]
1900s
* ''1902:'' Aetna created an Accident and Liability department to offer employers' liability and workmen's collective insurance, alongside the growing strength of the Progressive social reform movement. This would become the cornerstone of the Aetna Accident and Liability Company.[
* ''1903:'' An Engineering and Inspection Division was created to improve workplace safety.][
* ''1904:'' Aetna introduced its first ]corporate seal
A company seal (sometimes referred to as the corporate seal or common seal) is an official seal used by a company. Company seals were predominantly used by companies in common law jurisdictions, although in modern times, most countries have done ...
. The logo portrayed the company's home office bursting out from within a globe, with large block typeface spelling out Ae''tna's ranking.''
* ''1907:'' Aetna began offering automobile insurance. This business developed into the Aetna Casualty and Surety Company.[
* ''1908:'' Aetna hired its first home office female employee, Julia Kinghorn, a ]telephone switchboard
A telephone switchboard was a device used to connect circuits of telephones to establish telephone calls between users or other switchboards, throughout the 20th century. The switchboard was an essential component of a manual telephone exchange, ...
operator.
* ''1910:'' Under the management of E. E. Cammack, Aetna began using Hollerith
Herman Hollerith (February 29, 1860 – November 17, 1929) was a German-American statistician, inventor, and businessman who developed an electromechanical tabulating machine for punched cards to assist in summarizing information and, later, in ...
punched card
A punched card (also punch card or punched-card) is a piece of stiff paper that holds digital data represented by the presence or absence of holes in predefined positions. Punched cards were once common in data processing applications or to di ...
s machines for tabulating and hired 35 women to input mortality statistics on keypunch machines, the company's first female home office clerks.[
* ''1911:'' Aetna began its first national advertising campaign. The same year, Aetna formed a ]bond
Bond or bonds may refer to:
Common meanings
* Bond (finance), a type of debt security
* Bail bond, a commercial third-party guarantor of surety bonds in the United States
* Chemical bond, the attraction of atoms, ions or molecules to form chemica ...
department to market fidelity and surety
In finance, a surety , surety bond or guaranty involves a promise by one party to assume responsibility for the debt obligation of a borrower if that borrower defaults. Usually, a surety bond or surety is a promise by a surety or guarantor to pay ...
coverages.
* ''1912:'' Aetna introduced the first combination automobile policy, with several separate types of coverage combined into one contract. Several Aetna insureds were killed on the RMS Titanic
RMS ''Titanic'' was a British passenger liner, operated by the White Star Line, which sank in the North Atlantic Ocean on 15 April 1912 after striking an iceberg during her maiden voyage from Southampton, England, to New York City, United ...
.[
* ''1913:'' Aetna formed its second affiliate, the Automobile Insurance Company, to write fire insurance on cars.] This soon expanded to include windstorm
A storm is any disturbed state of the natural environment or the atmosphere of an astronomical body. It may be marked by significant disruptions to normal conditions such as strong wind, tornadoes, hail, thunder and lightning (a thunderst ...
, tornado
A tornado is a violently rotating column of air that is in contact with both the surface of the Earth and a cumulonimbus cloud or, in rare cases, the base of a cumulus cloud. It is often referred to as a twister, whirlwind or cyclone, altho ...
, leasehold
A leasehold estate is an ownership of a temporary right to hold land or property in which a lessee or a tenant holds rights of real property by some form of title from a lessor or landlord. Although a tenant does hold rights to real property, a l ...
, and ocean and inland marine insurance
Marine insurance covers the physical loss or damage of ships, cargo, terminals, and any transport by which the property is transferred, acquired, or held between the points of origin and the final destination. Cargo insurance is the sub-branch o ...
. Aetna formed a Group department to sell group life insurance.
*''1917:'' Aetna's name changes to Aetna Casualty and Surety Co.
*''1924:'' By 1924, Aetna had $94million, 43% of its assets, invested in farm mortgages. That year, Aetna acquired The Standard Fire Insurance Co.
* ''1960:'' Aetna expanded outside the U.S., buying a Canadian
Canadians (french: Canadiens) are people identified with the country of Canada. This connection may be residential, legal, historical or cultural. For most Canadians, many (or all) of these connections exist and are collectively the source of ...
company, Excelsior Life Insurance Company.
*''1968:'' In 1968, Aetna bought a majority interest in Producer's and Citizen's Cooperative Assurance Company of Sydney
Sydney ( ) is the capital city of the state of New South Wales, and the most populous city in both Australia and Oceania. Located on Australia's east coast, the metropolis surrounds Sydney Harbour and extends about towards the Blue Mountain ...
, Australia
Australia, officially the Commonwealth of Australia, is a Sovereign state, sovereign country comprising the mainland of the Australia (continent), Australian continent, the island of Tasmania, and numerous List of islands of Australia, sma ...
. Also in 1968, Aetna's stock debuted on the NYSE
The New York Stock Exchange (NYSE, nicknamed "The Big Board") is an American stock exchange in the Financial District, Manhattan, Financial District of Lower Manhattan in New York City. It is by far the List of stock exchanges, world's largest s ...
.
* ''1970:'' Aetna's Pension, Casualty and Life Division under the direction of B.E. Burton, President and Lead Actuary, saw billion-dollar growth in the post-ERISA pension administration segment.
*''1981:'' In 1981, Aetna bought a 40% interest in two Chile
Chile, officially the Republic of Chile, is a country in the western part of South America. It is the southernmost country in the world, and the closest to Antarctica, occupying a long and narrow strip of land between the Andes to the east a ...
an companies, and soon thereafter invested in ventures in England, Spain, Hong Kong
Hong Kong ( (US) or (UK); , ), officially the Hong Kong Special Administrative Region of the People's Republic of China ( abbr. Hong Kong SAR or HKSAR), is a city and special administrative region of China on the eastern Pearl River Delt ...
, Taiwan
Taiwan, officially the Republic of China (ROC), is a country in East Asia, at the junction of the East and South China Seas in the northwestern Pacific Ocean, with the People's Republic of China (PRC) to the northwest, Japan to the nort ...
, Indonesia
Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania between the Indian and Pacific oceans. It consists of over 17,000 islands, including Sumatra, Java, Sulawesi, and parts of Borneo and New Guine ...
and Korea
Korea ( ko, 한국, or , ) is a peninsular region in East Asia. Since 1945, it has been divided at or near the 38th parallel, with North Korea (Democratic People's Republic of Korea) comprising its northern half and South Korea (Republic o ...
.
* ''1996:'' Aetna sold its property and casualty subsidiary to The Travelers Companies
The Travelers Companies, Inc., commonly known as Travelers, is an American insurance company. It is the second-largest writer of U.S. commercial property casualty insurance, and the sixth-largest writer of U.S. personal insurance through indepen ...
. Also in 1996, Aetna acquired U.S. Healthcare, founded by Leonard Abramson
Leonard Abramson (born in 1932, Pennsylvania) is a philanthropist and the founder and former CEO of U.S. Healthcare.
Early life and career
Born in Pennsylvania, and raised in the Strawberry Mansion neighborhood of Philadelphia. . The company's name changed to Aetna Inc.
*''1998:'' In 1998, Aetna bought NYLCare Health Plans for $1.05billion, adding 2.2million members.
*''1999: Aetna'' bought Prudential HealthCare for $1billion, making it the largest provider of health benefits in the U.S., with more than 21million members.
2000s
* ''2000:'' Aetna hired John Rowe as CEO and president. Rowe cut over 10,000 jobs and raised insurance premiums between 11 and 13 percent per year. Under Rowe, the company spent more than $20million to revamp its computer systems, enabling the company to identify and discontinue unprofitable accounts. Within a few years, Aetna shed 8million covered lives due to premiums that customers could no longer afford. Also in 2000, Aetna sold its financial services and international businesses to ING Group
The ING Group ( nl, ING Groep) is a Dutch multinational banking and financial services corporation headquartered in Amsterdam. Its primary businesses are retail banking, direct banking, commercial banking, investment banking, wholesale bankin ...
for $7.7billion, spun off its health business to its shareholders
A shareholder (in the United States often referred to as stockholder) of a corporation is an individual or legal entity (such as another corporation, a body politic, a trust or partnership) that is registered by the corporation as the legal owner ...
, thus focusing its business as an independent health and group benefits company.
* ''2001:'' Aetna recruited global public relations and marketing executive Roy Clason Jr. to lead the company's reputation management strategies during Aetna's multi-year corporate turnaround campaign.
*''2002:'' In 2002, Rowe shrunk Aetna's customer base from 19million members to 13million by abandoning unprofitable markets, including almost half of the counties nationwide in which it offered Medicare products.
* ''2006:'' John Rowe stepped down as CEO and executive chairman of Aetna.
* ''2007:'' Aetna acquired plan operator Schaller Anderson in July, signaling a push into the growing business of running plans for Medicaid and the State Children's Health Insurance Program
The Children's Health Insurance Program (CHIP) – formerly known as the State Children's Health Insurance Program (SCHIP) – is a program administered by the United States Department of Health and Human Services that provides matching funds to ...
.
* ''2008:'' Aetna CEO Ron Williams received $38.12million in executive compensation
Executive compensation is composed of both the financial compensation (executive pay) and other non-financial benefits received by an executive from their employing firm in return for their service. It is typically a mixture of fixed salary, varia ...
. Also in 2008, Aetna began offering pet
A pet, or companion animal, is an animal kept primarily for a person's company or entertainment rather than as a working animal, livestock, or a laboratory animal. Popular pets are often considered to have attractive appearances, intelligence, ...
health insurance through Pets Best Insurance Services.
* ''2009:'' On September 22, more than 200 people gathered in front of Aetna's Hartford headquarters to call for a public health insurance option
The public health insurance option, also known as the public insurance option or the public option, is a proposal to create a government-run health insurance agency that would compete with other private health insurance companies within the Unite ...
they said is essential to true national health care reform
Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:
* Broaden the population that receives health care coverage through either public sector insur ...
. On October 2, Connecticut Attorney General Richard Blumenthal
Richard Blumenthal (; born February 13, 1946) is an American lawyer and politician who is the senior United States senator from Connecticut, a seat he has held since 2011. A member of the Democratic Party, he is one of the wealthiest members of ...
and Healthcare Advocate Kevin P. Lembo asked Aetna and four other insurance companies for information the companies may have sent policyholders regarding the impact of proposed legislation on Medicare Advantage and prescription drug programs. According to Blumenthal, some insurance companies exaggerated or stretched the impact of health care reform. On November 3, US Senator Tom Harkin
Thomas Richard Harkin (born November 19, 1939) is an American lawyer, author, and politician who served as a United States senator from Iowa from 1985 to 2015. A member of the Democratic Party, he previously was the U.S. representative for Iowa' ...
, chairman of the Committee on Health, Education, Labor and Pensions
The United States Senate Committee on Health, Education, Labor and Pensions (HELP) generally considers matters relating to these issues. Its jurisdiction also extends beyond these issues to include several more specific areas, as defined by Sena ...
, launched an investigation into health insurance pricing, asking Aetna and three other major insurers to justify their pricing practices. Also in November, Aetna announced the layoff of 3.5% of its work force, 625 employees. On November 30, Aetna CEO Ron Williams told analysts that Aetna would increase prices in 2010 and force 600,000 to 650,000 Aetna customers to drop their coverage. Aetna filed a $4.9billion correction to its 2008 health insurance regulatory filings on December 7, 2009. The new filings showed that Aetna spent less on small business health care than previously reported.
2010s
* ''2010:'' Aetna and Continuum Health Partners
The Mount Sinai Health System is a hospital network in New York City. It was formed in September 2013 by merging the operations of Continuum Health Partners and the Mount Sinai Medical Center.
The Health System is structured around eight hospit ...
had a contract dispute affecting coverage at various New York hospitals, and the contract lapsed. In July, a new contract was signed and coverage applied retroactively to the contract lapse.
*''2012:'' Aetna introduced a new company logo, designed by New York-based Siegel+Gale.
* ''2012:'' In June 2012, Aetna and Inova Health System announced a joint venture creating a new health insurance company, Innovation Health.
* ''2015:'' On July 3, 2015, Aetna announced that it planned to acquire Humana
Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. In 2021, the company ranked 41 on the Fortune 500 list, which made it the highest ranked (by revenues) company based in Kentucky. It has been the thir ...
for in cash and stock.
* ''2017:'' On January 23, 2017, John D. Bates, United States District Judge for the District of Columbia, blocked Aetna's merger with Humana, saying it would leave senior citizens with fewer options for Medicare coverage. On February 14, 2017, Aetna and Humana officially ended the $34billion merger agreement, after judges ruled against the merger a second time.
* ''2017:'' In June 2017, the company announced plans to move its headquarters to New York City
New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
in late 2018. After CVS announced the acquisition of Aetna in December 2017, CVS announced that the company's headquarters would remain in Hartford, scrapping plans to move to New York City.
* ''2017:'' On December 3, 2017, CVS Health
CVS Health Corporation (previously CVS Corporation and CVS Caremark Corporation) is an American healthcare company that owns CVS Pharmacy, a retail pharmacy chain; CVS Caremark, a pharmacy benefits manager; and Aetna, a health insurance prov ...
announced the acquisition of Aetna for $69billion. Larry Merlo became chief executive of the two brands. Aetna CEO Mark Bertolini
Mark T. Bertolini (born 1956) is an American businessman who is the Co-CEO of Bridgewater Associates, one of the world's largest hedge funds. He was previously the CEO of Aetna, a Fortune 50 diversified health care benefits company with over $60 ...
resigned and Aetna President Karen S. Lynch took over Aetna operations.
* ''2018:'' On November 28, 2018, CVS Health completed the acquisition of Aetna.
2020s
*''2020:'' In November, Karen Lynch was named CEO of CVS.
*''2021:'' In February, Lynch announced that Aetna would begin offering individual plans through ACA exchanges in 2022.
Lawsuits and regulatory action
1999
* A jury in California awarded $116million in punitive damages
Punitive damages, or exemplary damages, are damages assessed in order to punish the defendant for outrageous conduct and/or to reform or deter the defendant and others from engaging in conduct similar to that which formed the basis of the lawsuit. ...
for " malice, oppression
Oppression is malicious or unjust treatment or exercise of power, often under the guise of governmental authority or cultural opprobrium. Oppression may be overt or covert, depending on how it is practiced. Oppression refers to discrimination w ...
and fraud
In law, fraud is intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. Fraud can violate civil law (e.g., a fraud victim may sue the fraud perpetrator to avoid the fraud or recover monetary compens ...
" to a patient's widow who contended he died after a subsidiary of Aetna delayed approving treatment for stomach cancer
Stomach cancer, also known as gastric cancer, is a cancer that develops from the lining of the stomach. Most cases of stomach cancers are gastric carcinomas, which can be divided into a number of subtypes, including gastric adenocarcinomas. Lymph ...
that its own doctors had recommended. Lawyers on both sides called it the largest such verdict against a health maintenance organization
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded healt ...
. In 2001 a settlement was reached.
2000
* The U.S. Court of Appeals
The United States courts of appeals are the intermediate appellate courts of the United States federal judiciary. The courts of appeals are divided into 11 numbered circuits that cover geographic areas of the United States and hear appeals fr ...
affirmed a $1.855 million federal jury award for Brokerage Concepts Inc. (BCI) against Aetna U. S. Healthcare (formerly U. S. Healthcare), its Pennsylvania subsidiary
A subsidiary, subsidiary company or daughter company is a company owned or controlled by another company, which is called the parent company or holding company. Two or more subsidiaries that either belong to the same parent company or having a s ...
, and one of its former senior executives, Richard Wolfson. In its suit, BCI accused Aetna U. S. Healthcare of tortious interference
Tortious interference, also known as intentional interference with contractual relations, in the common law of torts, occurs when one person intentionally damages someone else's contractual or business relationships with a third party, causing e ...
with contractual relations. BCI alleged the managed-care company used its economic power in the business of prescription drug
A prescription drug (also prescription medication or prescription medicine) is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription. The rea ...
sales to coerce
Coercion () is compelling a party to act in an involuntary manner by the use of threats, including threats to use force against a party. It involves a set of forceful actions which violate the free will of an individual in order to induce a desi ...
one of BCI's clients, the "I Got It at Gary's" pharmacy
Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links heal ...
chain, into using another Aetna U. S. Healthcare subsidiary, Corporate Health Administrators, as its health benefits management firm. According to the suit, Aetna U. S. Healthcare threatened to drop "I Got it at Gary's" from its pharmacy network if the company didn't switch to Corporate Health Administrators.
2001
* The Maryland Insurance Commissioner
An insurance commissioner (or commissioner of insurance) is a public official in the executive branch of a state or territory in the United States who, along with his or her office, regulate the insurance industry. The powers granted to the office ...
ordered five Maryland health plans to pay a total of $1.4million in penalties for failing to comply with the state's claims payment practices; Aetna was cited twice and ordered to pay the largest fine of $850,000.
* The State of Texas fined Aetna $1.15million for failing to promptly pay doctors and hospitals for services. Texas Insurance Commissioner Jose Montemayor also ordered Aetna to pay restitution
The law of restitution is the law of gains-based recovery, in which a court orders the defendant to ''give up'' their gains to the claimant. It should be contrasted with the law of compensation, the law of loss-based recovery, in which a court o ...
to physicians and health care providers who did not receive timely payment for claims.
2002
* The New York Department of Insurance fined Aetna US Healthcare and UnitedHealthcare
UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. It offers health care products and insurance services. UnitedHealth Group is the world's seventh largest c ...
a total of $2.5million, citing mishandled claims, improper treatment denials
Denial, in ordinary English usage, has at least three meanings: asserting that any particular statement or allegation is not true (which might be accurate or inaccurate); the refusal of a request; and asserting that a true statement is not true. ...
, unlicensed health insurance agents
An insurance broker is an intermediary who sells, solicits, or negotiates insurance on behalf of a client for compensation. An insurance broker is distinct from an insurance agent in that a broker typically acts on behalf of a client by negoti ...
, and poorly performing claims processors using out-of-date software
Software is a set of computer programs and associated documentation and data. This is in contrast to hardware, from which the system is built and which actually performs the work.
At the lowest programming level, executable code consists ...
.
2003
* To settle a class-action lawsuit between Aetna and 700,000 physicians
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
and medical societies, Aetna agreed to streamline communications, reduce administrative complexity, and improve the quality of the health care system. The lawsuit
-
A lawsuit is a proceeding by a party or parties against another in the civil court of law. The archaic term "suit in law" is found in only a small number of laws still in effect today. The term "lawsuit" is used in reference to a civil actio ...
was settled for $470million and charged Aetna with systematically reducing payments to physicians and overriding their treatment decisions.
*Aetna and the American Dental Association (ADA) announced a class-action settlement by dentists who accused Aetna of interfering with dental procedures to cut costs and required dentists to comply with excessive paperwork. The settlement called for Aetna to pay $4million to 40,000 to 50,000 dentists and $1million to the ADA Foundation, a charitable
The practice of charity is the voluntary giving of help to those in need, as a humanitarian act, unmotivated by self-interest. There are a number of philosophies about charity, often associated with religion.
Etymology
The word ''charity'' or ...
group.
* Georgia Insurance Commissioner John W. Oxendine
John W. Oxendine (born April 30, 1962) is an Politics of the United States, American politician who served four terms as Insurance Commissioner of the U.S. state of Georgia (U.S. state), Georgia. A member of the Republican Party (United States ...
fined Aetna's Prudential Health Plan $100,000 for violating Georgia's prompt pay law by delaying claims payments. Aetna companies had been fined four previous times by Oxendine's office, in 2000 and again in 2002, for a total of $411,200.
2007
* The New Jersey Department of Banking and Insurance filed an administrative order levying a $9.5million fine against Aetna for refusing to cover certain services provided by out-of-network providers—including emergency treatment—in violation of New Jersey rules and regulations.
2009
* Former Aetna employee Cornelius Allison of Darby, Pa., filed suit against Aetna in U. S. District Court in Pennsylvania after hackers
A hacker is a person skilled in information technology who uses their technical knowledge to achieve a goal or overcome an obstacle, within a computerized system by non-standard means. Though the term ''hacker'' has become associated in popu ...
gained access to a company website
A website (also written as a web site) is a collection of web pages and related content that is identified by a common domain name and published on at least one web server. Examples of notable websites are Google Search, Google, Facebook, Amaz ...
holding personal data for 450,000 current and former employees, as well as job applicants. The suit charged Aetna with negligence
Negligence (Lat. ''negligentia'') is a failure to exercise appropriate and/or ethical ruled care expected to be exercised amongst specified circumstances. The area of tort law known as ''negligence'' involves harm caused by failing to act as a ...
, breach of contract
Breach of contract is a legal cause of action and a type of civil wrong, in which a binding agreement or bargained-for exchange is not honored by one or more of the parties to the contract by non-performance or interference with the other party ...
, negligent misrepresentation
In common law jurisdictions, a misrepresentation is a False statements of fact, false or misleading ''Royal Mail Case, R v Kylsant'' 931
Year 931 ( CMXXXI) was a common year starting on Saturday (link will display the full calendar) of the Julian calendar.
Events
By place
Europe
* Spring – Hugh of Provence, king of Italy, cedes Lower Burgundy to Rudolph II, in re ...
Question of law, statement of fact made during negotiations by one party to another, the statement then in ...
and invasion of privacy
The right to privacy is an element of various legal traditions that intends to restrain governmental and private actions that threaten the privacy of individuals. Over 150 national constitutions mention the right to privacy. On 10 December 194 ...
.
* The Arizona Department of Insurance fined Aetna Life Insurance Company and Aetna Health, Inc. after examination of their practices exposed multiple violations of Arizona insurance laws. The department found that Aetna violated state laws governing areas of health insurance operations, including Aetna's: failure to provide policyholders with information about their rights on appeals
In law, an appeal is the process in which cases are reviewed by a higher authority, where parties request a formal change to an official decision. Appeals function both as a process for error correction as well as a process of clarifying and ...
of medical claims or services denials; failure to acknowledge receipt of policyholder appeals; failure to notify policyholders about appeal decisions/outcomes; and, in some appeals involving the denial of services for potentially life-threatening conditions, failure to inform policyholders of their decision within the required, expedited time frames.
2010
* Aetna paid a $750,000 fine as part of a settlement with the New York Insurance Department
The New York State Insurance Department (NYSID) was the state agency responsible for supervising and regulating all insurance business in New York State.[History, About Us, New York State Department of Financial Services, retrieved on March 5, 2012 ...
related to the company administering an affordable healthcare plan for the state. Aetna's violations included: failing to provide a required 30-day notice of rate increases to about 946 members in 2007, failing to provide notice to 1,406 terminated workers of their rights to convert to another policy, failing to report enrollment data from May 2007 through August 2008, and failing to respond to Insurance Department requests for data in March 2008.
2018
* On February 11, 2018, CNN reported that the California Department of Insurance launched an investigation into Aetna following sworn testimony from Dr. Jay Ken Iinuma, a former medical director for the insurer, in a lawsuit against the insurer in which he revealed he never reviewed any patients' medical records when deciding whether to approve or deny claims for coverage. The California Insurance Commissioner
The California insurance commissioner has been an elected executive office position in California since 1991. Prior to that time, the insurance commissioner was appointed by the governor. The officeholder is in charge of the California Departme ...
, Dave Jones, issued a statement confirming the investigation the following day. On February 27, 2018, the ranking members of the Senate Committee on Finance
The United States Senate Committee on Finance (or, less formally, Senate Finance Committee) is a standing committee of the United States Senate. The Committee concerns itself with matters relating to taxation and other revenue measures generall ...
and Committee on Health, Education, Labor, and Pensions, Senators Ron Wyden
Ronald Lee Wyden (; born May 3, 1949) is an American politician and retired educator serving as the Seniority in the United States Senate, senior United States Senate, United States senator from Oregon, a seat he has held since 1996 United Stat ...
and Patty Murray
Patricia Lynn Murray (; born October 11, 1950) is an American politician and educator who is the senior United States senator from Washington since 1993. A member of the Democratic Party, Murray was in the Washington State Senate from 1988 to ...
, issued a letter to Aetna demanding further information regarding Dr. Iinuma's testimony and the insurer's medical claims determination and patient appeal processes. In 2019, Aetna settled the lawsuit, but the California investigation continued.
*In 2018, a state jury in Oklahoma ruled against Aetna for $26.5 million in Ron Cunningham v. Aetna, with much of the damages arising from insurance bad faith
Insurance bad faith is a tort unique to the law of the United States (but with parallels elsewhere, particularly Canada) that an insurance company commits by violating the "implied covenant of good faith and fair dealing" which automatically exis ...
.
2021
* On September 11, 2021, attorney Brian Adesman
Brian (sometimes spelled Bryan (given name), Bryan in English) is a male given name of Irish language, Irish and Breton language, Breton origin, as well as a surname of Occitan language, Occitan origin. It is common in the English-speaking world.
...
filed suit against Aetna in a federal class action lawsuit, alleging that "in administering the Aetna Plans, Aetna treats mental health as less important than physical health." Regarding the lawsuit, attorney Brian Adesman
Brian (sometimes spelled Bryan (given name), Bryan in English) is a male given name of Irish language, Irish and Breton language, Breton origin, as well as a surname of Occitan language, Occitan origin. It is common in the English-speaking world.
...
was reported in the media saying, "Insurance companies are not above the law and profits can’t come before people."
Life insurance policies on slaves
In 2000, Deadria Farmer-Paellmann, head of the nonprofit Restitution Study Group of Hoboken, New Jersey, disclosed that, from approximately 1853 to 1860 Aetna, had issued life insurance policies to slaveowners covering the lives of their slaves.
Aetna acknowledged that concrete evidence exists for Aetna issuing coverage for the lives of slaves and released a public apology.
In 2002, Farmer-Paellmann brought suit against Aetna and two other companies in federal court asking for reparations for the descendants of slaves. The lawsuit said Aetna, CSX
CSX Transportation , known colloquially as simply CSX, is a Class I freight railroad operating in the Eastern United States and the Canadian provinces of Ontario and Quebec. The railroad operates approximately 21,000 route miles () of track. ...
and Fleet were "unjustly enriched" by "a system that enslaved, tortured, starved and exploited human beings." It argued that African-American
African Americans (also referred to as Black Americans and Afro-Americans) are an Race and ethnicity in the United States, ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American ...
s are still suffering the effects of two and a half centuries of enslavement followed by more than a century of institutionalized racism. The complaint blamed slavery for present-day disparities between blacks and whites in income, education, literacy, health, life expectancy and crime.
This suit was dismissed, and the dismissal largely upheld on appeal.
In 2006, Farmer-Paellmann announced a nationwide boycott
A boycott is an act of nonviolent, voluntary abstention from a product, person, organization, or country as an expression of protest. It is usually for moral, social, political, or environmental reasons. The purpose of a boycott is to inflict som ...
of Aetna over the issue of reparations
Reparation(s) may refer to:
Christianity
* Restitution (theology), the Christian doctrine calling for reparation
* Acts of reparation, prayers for repairing the damages of sin
History
*War reparations
**World War I reparations, made from G ...
for its policies covering slaves. Aetna stated that its commitment to diversity in the workplace and its investment of over $36million in such areas as education, health, economic development, community partnerships, and minority-owned business initiatives in the African-American community are more effective at aiding descendants of slaves and African-Americans in general than making restitutions for Aetna's life insurance policies on slaves.
Lobbying and campaign contributions
Aetna has spent more than $2.0million in 2009 on lobbying
In politics, lobbying, persuasion or interest representation is the act of lawfully attempting to influence the actions, policies, or decisions of government officials, most often legislators or members of regulatory agency, regulatory agencie ...
. The company spent $809,793 between January 2009 and the end of March 2009—up 41 percent from the same period in 2008. Aetna's campaign contributions
Campaign finance, also known as election finance or political donations, refers to the funds raised to promote candidates, Political party, political parties, or policy initiatives and referendums. Political parties, charitable organizations, a ...
include more than $110,000 to US Senator Joe Lieberman
Joseph Isadore Lieberman (; born February 24, 1942) is an American politician, lobbyist, and attorney who served as a United States Senate, United States senator from Connecticut from 1989 to 2013. A former member of the Democratic Party (Uni ...
(ID-CT) in 2009. From 2005 through 2009, Aetna contributed $56,250 to Senator Max Baucus
Maxwell Sieben Baucus ( Enke; born December 11, 1941) is an American politician who served as a United States senator from Montana from 1978 to 2014. A member of the Democratic Party, he was a U.S. senator for over 35 years, making him the long ...
(D-MT), chairman of the Senate Finance Committee
The United States Senate Committee on Finance (or, less formally, Senate Finance Committee) is a standing committee of the United States Senate. The Committee concerns itself with matters relating to taxation and other revenue measures generall ...
, making Aetna the senator's seventh highest contributor over that time period.
See also
* Aetna Building
* List of United States insurance companies
This is a list of insurance companies based in the United States. These are companies with a strong national or regional presence having insurance as their primary business.
In 1752, Benjamin Franklin founded the first American insurance company a ...
;Related topics
* Drivotrainer
The Drivotrainer was an automobile driving simulator promoted by the Aetna Insurance Company and widely used in driver training classes.[Health care reform in the United States
Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes enacted in 2010: the Patient Protection and Affordab ...]
* Health care reform debate in the United States
The healthcare reform debate in the United States has been a political issue focusing upon increasing medical coverage, decreasing costs, insurance reform, and the philosophy of its provision, funding, and government involvement.
Details
Du ...
* Health insurance
Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
* Life insurance
Life insurance (or life assurance, especially in the Commonwealth of Nations) is a contract between an insurance policy holder and an insurer or assurer, where the insurer promises to pay a designated beneficiary a sum of money upon the death ...
* Managed health care
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("ma ...
* Medicare Advantage
* Pet insurance
Pet insurance is a form of insurance that pays, partly or in total, for veterinary treatment of the insured person's ill or injured pet. Some policies will pay out when the pet dies, or if the pet is lost or stolen.
As veterinary medicine is in ...
* Public health insurance option
The public health insurance option, also known as the public insurance option or the public option, is a proposal to create a government-run health insurance agency that would compete with other private health insurance companies within the Unite ...
References
External links
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American companies established in 1853
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Health maintenance organizations
Pharmacy benefit management companies based in the United States
Reparations for slavery