California investigates Aetna as medical director admits under oath he never looked at records

It has been long understood that insurance companies make money by balancing collection of premiums with distribution of care. Accusations that this is tantamount to denying care for profits are hard to ignore after a recent revelation–under oath–that Aetna’s Medical Director routinely made decisions about whether or not to pay for care without ever looking at the specific patient’s medical records at all.
California Insurance Commissioner Dave Jones expressed outrage after media outlet CNN showed him a transcript of the testimony. He 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.
The insurance commissioner said Californians who believe they may have been adversely affected by Aetna’s decisions should contact his office.
Members of the medical community expressed similar shock, saying Iinuma’s deposition leads to questions about Aetna’s practices across the country.

See the article on CNN here.

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