CNN: California launches investigation following stunning admission by Aetna medical director
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.htmlCalifornia'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.
Jones said his expectation would be "that physicians would be reviewing treatment authorization requests," and that it's troubling that "during the entire course of time he was employed at Aetna, he never once looked at patients' medical records himself."
"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.
Aetna, the nation's third-largest insurance provider with 23.1 million customers, told CNN it looked forward to "explaining our clinical review
gilligan
(194 posts)I am alive but the insurance companies sure didn't give a rats ass. For that matter neither did my fucking doctor. I was begging him to check me out because something was wrong. Finally he did just in time. Stage 3 colon cancer, That was 14 years ago.
Oh and just because I feel good.
FUCK TRUMP!
Stuart G
(38,445 posts)My dentist found mine, then to an oral surgeon, and then to MD. an Ears, Nose and Throat Dr...
He performed surgery in the hospital operating room. (Fortunately, the Ears, Nose and Throat Doc..had to perform 2 other surgeries to get it all..and he did!!!!!!, yes, my insurance paid for the 3 surgeries in the hospital, not for the dentists and oral surgeon, a dental specialist)
OH..and just because I feel good too..
FUCK TRUMP!
demigoddess
(6,644 posts)only stage 2 cancer, thank heaven.
txwhitedove
(3,929 posts)fuck tRump!
gtar100
(4,192 posts)Big talking point against single payer Healthcare or expanding Medicare to everyone. They railed against these ideas because they didn't want a government "panel" getting between their health care and their doctor.
Exactly as one would expect of republicans, they don't say a word about it when a for-profit company does exactly that.
Tell me why CEOs *and* investors deserve lavish lifestyles paid for by money we set aside for our health care. They do not deserve profits, especially if they are as negligent as Aetna has been as mentioned above. I would bet my bottom dollar this is a widespread practice. Their incentives aren't to be part of an effective system of care for people. Their incentives are dictated by *not* spending our money (that we give to them precisely for health care) on the services we need. Their incentive is to spend only the bare minimum on actual health services in order to keep the wheels turning.
Victor_c3
(3,557 posts)Corporations are the bane of America. Their sole purpose is to exploit and pump society for wealth to feed to their share holders. Nothing other than an increasing share value matters. Theyll skirt the laws and do that bare minimum in terms of safety and acting ethically to get by and, when they think nobody is looking, theyll gladly break the law too.
Aetna is just another example of a long line of corporate exploits and fraud like Bophal, Citibank and their drug cartel laundering scheme, VW and clean diesel, BP and their oil spill in the gulf, etcetera. Then, to ad insult to it all, theyre able to write off all fines on their taxes. CEO will lose their job and get a multi-million dollar bonus and severance package. Jail is just about never on the table.
The again, Im preaching to the choir when I go off on a rant like that on DU....
Auggie
(31,187 posts)Their cost-cutting is partially if not 100% responsible for causing many of these horrendous Northern California wildfires.
Corporations may have had their day 120 years ago when they needed investment to help build their infrastructure, but those days are long behind us.
I dont trust PG&E with my safety and would welcome and encourage the State of California to take over their operations and run electrical/gas delivery as a non-profit. And when they do any excess revenue can go towards increasing sustainable power production, improving emergency response and burying as many existing power lines as possible.
questionseverything
(9,659 posts)since healthcare is a human right in a civilized country, we really need to get rid of them
erronis
(15,328 posts)The rest of us deserve to pay premiums, co-pays, out-of-pocket, and with our health and lives because they deserve the best.
The repuglicon way: deflect, deny, denigrate, and demolish. And figure out how to make $$$s while screwing the rest.
Victor_c3
(3,557 posts)I like to remind people of that. If youre poor its usually because you dont work hard enough and you make poor life decisions.
Or it could be that youre poor because your head came out of the wrong vagina and/or you have a moral conscience and feel guilty about destroying other people so you can make a few dollars.
America is not a meritocracy, but republicans dont want to hear that.
erronis
(15,328 posts)And, republicons know full well that this ain't a meritocracy. If if were, they'd all be out panhandling..... Well, I guess that's what they do naturally.
ck4829
(35,091 posts)OMGWTF
(3,975 posts)SHRED
(28,136 posts)calimary
(81,466 posts)I think we should hijack that talking point and use it for OUR purposes. Unlike the GOP, well be telling the truth.
Wawannabe
(5,678 posts)FUCK tRump!!!
Found out the other day that my landlord is a tRumphumper. Geez. It was a conversation about healthcare.
He actually stated that Obamacare (his words I call it ACA) made their insurance rates higher and that it was a good thing that *cough* tRump was fixing it.
They are old and have preexisting conditions from hell! ACA made it to where they could actually get coverage for those conditions.
FUCK tRump!
blueinredohio
(6,797 posts)I figured I knew what I had which wasn't too bad so why change to something I know nothing about. Now I'm glad I did.
Grammy23
(5,813 posts)If medical records were not part of that equation, what did you use? A crystal ball?
Just asking as a 28 year breast cancer survivor who would have been dead long ago if my insurance company decided theyd already spent enough on me.
Igel
(35,356 posts)MD at top, handling lots of cases per day; staff of some sort of nurses or other non-MDs reporting to him.
From the article:
"Did you ever look at medical records?" Scott Glovsky, Washington's attorney, asked Iinuma in the deposition.
"No, I did not," the doctor says, shaking his head.
"So as part of your custom and practice in making decisions, you would rely on what the nurse had prepared for you?" Glovsky asks.
"Correct."
Iinuma said nearly all of his work was conducted online. Once in a while, he said, he might place a phone call to the nurse for more details.
How many times might he call a nurse over the course of a month?
"Zero to one," he said.
What the nurse provided was probably a precis of the case--name not important, but diagnosis, relevant info like age and sex, standard treatments, prescribed treatment. Maybe something else, depending on case. In other words, what the case manager would look for, but all nicely summarized for him. (With, of course, the possibility of transcription errors.)
My GP years ago was expected to see something like 24-28 patients a day and seldom failed to run late, sometimes an hour or more. Insurance case managers have far more than that. With the requirement that administrative costs be reduced under recent legislation, it's probably past just profit motive (unless "have profits" is a motive).
As for not knowing everything about everything, that strikes me as reasonable. My GP ran into problems trying to diagnose me, and (of course) managed to put himself a couple of patients behind looking up differential diagnoses and tests, plus prescription just in case his suspicion was correct. A previous doctor, dept. head, went with "easy" instead of "correct" in order to stay on schedule. Or, as was the case, "maintain efficiency." Whenever you hear "we need to increase efficiency to reduce costs" keep this in mind. It's the same where you and I work as where MDs and nurses work.
SWBTATTReg
(22,166 posts)repugs of wanting sick people to 'just die'...Aetna and the other insurance companies must have taken this to heart when they heard this.
kimbutgar
(21,188 posts)Additional help she needed, her husband confronted the doctor and said what would you do if it was your wife? The next day, my friends husband got the call saying they would give her the additional OT and an extra week in rehab while he arranged for in home care.
I fought back at Kaiser years ago for my autistic son. In a room with all these doctors and administrators. It was scary but I spoke from the heart holding a picture of my son. I got a letter a few days later giving me one year of outside therapy for my son paid by them.the therapist was surprised I won. I learned that If you dont ask or fight back youll never know if you can win.