AETNA VERDICT: Consumer Advocate Further Faults Insurer
In an op-ed in today's Los Angeles Times, Jamie Court of Consumers for Quality Care blasts Aetna for its response to the $120 million judgement handed down by a jury last week after the insurer failed to cover potentially life-saving treatment. Court states: "The jury's message was that Aetna cannot ignore its own doctors' recommendations and must act more quickly when a patient's life hangs in the balance. ... The verdict was a repudiation of a common HMO tactic of refusing to authorize treatment in a timely manner and then blaming the patient for doing what he or she must do to stay alive." He quotes Aetna CEO Richard Huber as saying of the ruling, "That's no way to get justice and certainly no way to manage a trillion-dollar industry." Court writes, "Aetna's board of directors would do well to consider that it is precisely Huber's attitude that the company is above justice that has gotten Aetna into trouble."
On Their Best Behavior
Court notes that an infamous Aetna training video demonstrated that the company treats patients differently depending on whether or not their health plan allows them to sue the insurer under the Employee Retirement Income Security Act. He also writes that after a court ruling established ERISA's "shield of legal immunity" from suits filed by non-government employees, Aetna "dropped its field investigation force, eliminated its claims handling guidelines and increased its claims personnel caseloads four to 4.5 times the industry average." He calls on Congress to "move swiftly to give patients who are insured by HMOs through private industry the same right to sue as government workers have." Court also called on the government to "block Aetna's pending merger with Prudential until it agrees to improve its authorization process" (1/27).
Aetna to Appeal $2M Antitrust Verdict
In separate news, Aetna Inc. announced yesterday that it will appeal a verdict handed down by a federal judge Monday, who ruled that Aetna engaged in anti-competitive practices with another insurer in King of Prussia, PA. The court found that an Aetna acquisition, U.S. Healthcare, had threatened to drop a local pharmacy chain from its HMO network unless the pharmacies purchased insurance for their employees from U.S. Healthcare and dropped their coverage from Brokerage Concepts Inc., the plaintiff in the suit. The judge held Aetna U.S. Healthcare and Richard Wolfson, a former executive, liable for $105,000 in compensatory damages. In addition, Aetna will pay $1.25 million and Wolfson $500,000 in punitive damages( Hartford Courant, 1/27).