California launches investigation following stunning admission by Aetna medical director [View all]

[deminks]

Source: CNN

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.

(snip)

Iinuma said he never looked at a patient's medical records while at Aetna. He says that was Aetna protocol and that he based his decision off "pertinent information" provided to him by a nurse.

(end snip)



Read more: http://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

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Explosive testimony. And, I suspect, widespread practice. I hope they look at how the doctors and nurses are paid by Aetna, for example, bonuses.