Connecticut Attorney General George Jepsen announced today that Aetna and American Specialty Health Networks, Inc. have agreed to review and reprocess chiropractic benefit claims that may have been denied improperly under Connecticut law.
The company was responding to questions raised by the Attorney General after several complaints were made by chiropractic providers on behalf of themselves and their patients. They were concerned that Aetna’s claims administration agreement with American Specialty Health Network, which took effect July 1, did not appear to include all the chiropractic services covered under Connecticut law.
Connecticut law requires health insurance plans to cover chiropractic care “to the same extent” coverage is provided for services rendered by a physician.
“Aetna’s prompt and fair response to this issue means providers will be paid for covered services and Aetna’s enrollees will continue to receive the care to which they are entitled,” Jepsen said. “Everyone benefits from this cooperation.”
Chiropractors licensed in Connecticut are permitted to provide a wide range of services, such as the use of X-ray and other diagnostic technology, the administration of foods and vitamins and preventative care. If health insurance plans cover those services when provided by physicians, they also must be covered when provided by chiropractors in Connecticut.
Aetna told Jepsen the claim system will be updated to include the procedure codes for qualifying services a chiropractor can provide in Connecticut. In addition, ASHN will review eligible claims submitted since July 1 and reprocess those denied incorrectly. No estimate was available on the number of claims affected.
Since July 1, American Specialty Health Network has provided claims administration and other services for chiropractic benefits available under Aetna’s health insurance plans with the exception of Aetna’s Traditional Choice plans in Connecticut.
The matter was handled by Assistant Attorney General Charles Hulin with Department Head Arnold Menchel of the Health Care Fraud Unit.
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