State To Investigate Aetna’s Approval Practices After Ex-Medical Director Admits He Never Looked At Records
Dr. Jay Ken Iinuma, a former medical director for Aetna, said he was following the company's training, in which nurses reviewed records and made recommendations to him.
CNN:
State Launches Aetna Probe After Stunning Admission
California's insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients' records when deciding whether to approve or deny care. California Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna. "If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that's of significant concern to me as insurance commissioner in California -- and potentially a violation of law," he said. (Drash, 2/11)
San Francisco Chronicle:
California Department Of Insurance Opens Investigation Into Aetna
“If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California — and potentially a violation of law,” [Jones] said. (Thadani, 2/11)