California launches Aetna investigation

Remember “The Rainmaker”, based on a John Grisham novel? I kept telling people it really was a documentary:

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.

“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 process” to the commissioner.

3 Responses to California launches Aetna investigation

  1. Imhotep February 13, 2018 at 11:15 am #

    The profit motive must be eliminated from our health care system.
    Which means that every health insurance company must be disbanded.

    In many cases the only solution to an existing problem is Socialism. Delivering health care to every American is such a case. The solution is not more privatization and bigger profits to satisfy Republicans and Wall Street.

    But not to worry because Trump’s 2019 budget calls for Medicare to be cut by $500 billion dollars.
    That should fix our health care problems.

  2. Lless February 13, 2018 at 2:03 pm #

    It never ends. I am now 2 hours and 10 minutes into a three hour window for a return call from an eligibility tech for Blue Cross. I reach Medicare eligibility next month. The gaps in even this “socialist” coverage are significant. You will need a supplement plan or Advantage coverage to avoid bankruptcy. This is how the private sector reaches back in to return you to capitalist realism.

  3. Doug in Oakland February 13, 2018 at 3:52 pm #

    When I had my stroke in ’08, I had missed the open enrollment window for Kaiser at the job I was working, so I was uninsured.
    There were some stressful times in that pre-ACA healthcare world, wondering whether I would be covered for the months of hospital and rehab I received before I could function well enough to go home, but in retrospect, I had it better than some of my fellow patients who did have insurance and seemed to spend a lot of the precious time you have to recover from a stroke that you only get one chance at, fighting with their insurance companies to try and get a few more days of rehab.
    Perhaps if I had not become disabled from the stroke and was able to return straight to work it would have been different, I’ll never know.
    And as far as Medicare, which I get from being disabled, covering your actual healthcare expenses, it really seems like that depends on where you live.
    Here in Oakland, we have Highland Hospital, which is somewhat overloaded, but the care there is top-flight. In 2015 I had cataract surgeries there that brought me back from blindness to 20/25 in my right eye and 20/40 in my left, and between Medicare and the sort of Medi-Cal I got after the expansion from the ACA, I was covered.
    According to my primary care doctor, who works there also, they would have done it even without Medi-Cal.
    None of the private clinics that were my other option would have done so, and from what I gathered while researching my options, only one of them would have done it without the 20% Medicare doesn’t cover up front. Of course that was in late 2014, and there was still a lot of uncertainty about what the ACA really did, so the situation may be different now, but that was my experience.

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