Dr. Jay Ken Iinuma, a former medical director at Aetna, admitted under oath that he never looked at patients’ records when deciding whether to approve or deny care.
California’s insurance commissioner Dave Jones was shown a transcript of Iinuma’s testimony; Jones told the broadcaster that his office is investigating the extent of this practice. “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,” Jones said.
Gillen Washington was denied coverage for an intravenous immunoglobulin. Iiluma claimed that he was following his training that Aetna provided. He explained that nurses reviewed the records and gave him recommendations. He did not know about the condition or the appropriate treatment for the condition Gillen Washington has.
Aetna made a statement saying, ” While the insurer emphasized that its medical directors “take their duties and responsibilities as medical professionals incredibly seriously,” it noted that they “work collaboratively with our nurses” whose input is factored in to the “decision-making process.”
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