CNN: California launches investigation following stunning admission by Aetna medical director

[Stuart G]

https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

California'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]

1. I had cancer

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]

2. Congratulations on your survival of cancer..I survived it too..

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]

14. with me it was the doctors did not take me seriously, finally one did

only stage 2 cancer, thank heaven.

[NurseJackie]

18. ...

[txwhitedove]

3. Drat, my company switched to Aetna. And always,

fuck tRump!

[gtar100]

4. Remember the republican skreed about "death panels"?

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]

9. Even worse than that, their purpose is to extract wealth for their share holders

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. They’ll 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, they’ll 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, they’re 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, I’m preaching to the choir when I go off on a rant like that on DU....

[Auggie]

17. +1. Add public utilities to the list, specifically PG&E

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 don’t 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]

19. insurance companies profit model depends on denying service

since healthcare is a human right in a civilized country, we really need to get rid of them

[erronis]

10. They deserve their lavish lifestyles because they are entitled, know the right people.

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]

12. Rich people are rich because they work harder and are smarter than the rest of us

I like to remind people of that. If you’re poor it’s usually because you don’t work hard enough and you make poor life decisions.

Or it could be that you’re 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 don’t want to hear that.

[erronis]

15. I like your analogy about the birth canal. Of course it has to be within a "good" family.

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]

25. Never forget

[OMGWTF]

5. Violation of the law? How about premeditated murder by spreadsheet?

[ck4829]

24. True

[SHRED]

6. Can you say "death panel"?

[calimary]

16. Yes. This would actually qualify, quite literally, as a death panel.

I think we should hijack that talking point and use it for OUR purposes. Unlike the GOP, we’ll be telling the truth.

[Wawannabe]

7. And just because!

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!

[ck4829]

23. +1

[blueinredohio]

8. A couple years ago we were offered to keep Anthem or switch to Aetna.

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]

11. So go ahead. Explain just how did you decide who to approve or who to decline??

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 they’d already spent enough on me.

[Igel]

20. What I was told would be industry standard back in '96.

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:

He says that was Aetna protocol and that he based his decision off "pertinent information" provided to him by a nurse.

"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]

13. This takes back to that rep who on the floor of Congress and held up a sign that accuses the ...

repugs of wanting sick people to 'just die'...Aetna and the other insurance companies must have taken this to heart when they heard this.

[ck4829]

22. Indeed

[ck4829]

21. Kick

[kimbutgar]

26. My friend had a stroke and since it was her second one the doctor was going to deny her the

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 don’t ask or fight back you’ll never know if you can win.

[dalton99a]

27. Kick