Colorado Joins Inquiry Into Aetna’s Approval Practices Following Former Medical Director’s Testimony
Dr. Jay Iinuma admitted under oath he never looked at patients' records when deciding whether to approve or deny care. Instead, he relied on nurses employed by Aetna to review the medical records and feed him pertinent information. California regulators have also launched an investigation into the company's practices.
Modern Healthcare:
Two States Question Aetna's Prior-Authorization Practices Amid CVS Merger
Two states are scrutinizing Aetna's processes for approving or denying payment for medical care after a former Aetna medical director admitted he never reviewed patient medical records when deciding whether to authorize treatment. The states' inquiries and the medical director's admission, which drew scorn from the medical community, are a public relations nightmare for Hartford, Conn.-based Aetna, and puts a microscope on the insurance industry's pre-authorization and appeals processes. It could also hamper the national insurer's ability to merge with pharmacy giant CVS Health. (Livingston, 2/13)
California Healthline:
California’s Regulators To Investigate Aetna’s Medical Coverage Decisions
Both of California’s health insurance regulators said they will investigate how Aetna Inc. makes coverage decisions, as the lawsuit of a California man who is suing the nation’s third-largest insurer for improper denial of care heads for opening arguments on Wednesday. The Department of Managed Health Care, which regulates the vast majority of health plans in California, said Monday it will investigate Hartford, Ct.-based Aetna after CNN first reported Sunday that one of the company’s medical directors had testified in a deposition related to the lawsuit that he did not examine patients’ records before deciding whether to deny or approve care. (Ostrov, 2/13)
