Aetna, the 3rd insurance company in the USA, has been put under investigation by California Insurance Commissioner, Dave Jones after the former Aetna medical director declared that he was approving or denying care without studying the patients’ dossiers.
The investigation is meant to observe if such a practice is common inside Aetna.
The former medical director of Aetna, Dr.Jay Ken Iinuma admitted that he followed the company’s training and said that it is the company’s policy to let nurses review the dossiers and send their recommendations to the medical director.
Dave Jones said that “physicians would be reviewing treatment authorization requests (…) but during the entire course of time he was employed at Aetna, he never once looked at patients’ medical records himself”, making reference to the case of Dr. Jay Ken Iinuma.
During the investigation, any patient of Aetna that considers himself mistreated by the aforementioned insurance company can contact Dave Jones’s office.
Iinuma’s declarations created reverberations in the medical community all over the US as many doctors and medical staff members are now questioning Aetna practices all over the States.
Even more, the former Aetna’s medical director’s testimonies came up during the lawsuit opened against Aetna by a former client, Gillen Washington.
Gillen Washington’s experience with Aetna
Gillen was suffering from a very rare immune condition and he stated that Aetna showed bad faith as it broke the contract denying him the coverage for an IVIG intervention – an infusion of intravenous immunoglobulin.
Aetna’s response was that Gillen did not offer them his blood work, as requested. Moreover, the company’s spokesman stated that Aetna paid every single infusion Gillen Washington needed but they were obliged by their internal policy to overview the young man’s medical dossier after his clinic asked Aetna to pre-approve an infusion.
Just then, Aetna representatives noticed that Gillen’s blood work in the dossier was three years old and asked him for a new probe.
The investigation on Aetna has just started and it might take some time until a clear verdict will be pronounced.