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Three States Join Inquiry of Aetna

Colorado, Washington, and Connecticut have joined California in investigating Aetna after a former medical director for the insurer admitted under oath that he never looked at patients’ medical records when deciding whether to approve or deny care...
February 21, 2018

Colorado, Washington, and Connecticut have joined California in investigating Aetna after a former medical director for the insurer admitted under oath that he never looked at patients’ medical records when deciding whether to approve or deny care.

Aetna responded by saying the comments in the deposition were “taken out of context” and that “medical records were in fact an integral part of the clinical review process.” The insurer also released a sworn statement by the former medical director, Dr. Jay Ken Iinuma, in which he said he looked at relevant portions of patients’ records, just not their entire records.

California Insurance Commissioner Dave Jones said, “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.” Watch Video

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