DOTmed Home MRI Oncology Ultrasound Molecular Imaging X-Ray Cardiology Health IT Business Affairs
News Home Parts & Service Operating Room CT Women's Health Proton Therapy Endoscopy HTMs Mobile Imaging
SEARCH
Current Location:
>
> This Story


Log in or Register to rate this News Story
Forward Printable StoryPrint Comment

 

 

Business Affairs Homepage

Samsung in talks with Japan’s Nipro for medical device division sale May sharpen focus on diagnostic imaging solutions

Philips inks 15-year $75 million MES deal with Children’s Health in Texas Are these contracts the future of value-based care?

Medtronic in $1.6 billion deal for Mazor Robotics 'We believe robotic-assisted procedures are the future of spine surgery'

DOJ clears Cigna, Express Scripts deal The $52 billion mega-deal will move forward

Trimedx to acquire Aramark's health tech business for $300 million Expands reach to more than 500 healthcare providers

UPDATE: Agfa responds to acquisition interest from Kanteron Systems X-ray leader 'has decided not to engage in discussions' at this time

Johnson & Johnson acquires Emerging Implant Technologies GmbH Company aims to improve spinal fusion technology and outcomes

Dr. Charles Stacey Accreditation Council for Medical Affairs appoints Accera CEO to board of governors

Will Agfa-Gevaert be acquired by Kanteron Systems? Software company pitches buy, points to stagnant Agfa Healthcare revenue and synergies

Stryker to acquire Invuity for $7.40 per share in cash Develops tools to boost visualization during surgery

California launches Aetna probe after incendiary testimony by insurer's former SoCal medical director

by Thomas Dworetzky , Contributing Reporter
Aetna's former Southern California medical director has admitted under oath that he didn't examine patients' records when determining whether to okay coverage, according to a CNN report.

When the network presented the transcript of the testimony to California Insurance Commissioner Dave Jones, it so alarmed him that he has now launched an investigation.

Story Continues Below Advertisement

Servicing GE Nuclear Medicine equipment with OEM trained engineers

We offer full service contracts, PM contracts, rapid response, time and material,camera relocation. Nuclear medicine equipment service provider since 1975. Click or call now for more information 800 96 NUMED



"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," said Jones.

The insurer told the network that it was eager to explain “our clinical review process" to authorities.

The probe concerns a deposition by the Aetna medical director for Southern California from March, 2012, to February, 2015, Dr. Jay Ken Iinuma.

According to the testimony, the physicians said that he followed Aetna's training and had nurses review records and recommend action to him.

"It's hard to imagine that in that entire course in time, there weren't any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional," Jones told CNN.

"That's why we've contacted Aetna and asked that they provide us information about how they are making these claims decisions and why we've opened this investigation."

The commissioner has called on all Californians who might have been negatively impacted by the Aetna process to reach out to his office.

The California situation has led other health care professionals nationwide to raise the alarm about possible Aetna practices.

Dr. Andrew Murphy, a fellow of the American Academy of Allergy and Immunology told the network that "this is potentially a huge, huge story and quite frankly may reshape how insurance functions."

"This is something that all of us have long suspected, but to actually have an Aetna medical director admit he hasn't even looked at medical records, that's not good," he told the network, adding that, "if he has not looked at medical records or engaged the prescribing physician in a conversation – and decisions were made without that input – then yeah, you'd have to question every single case he reviewed."

The former Aetna medical director's testimony came during a lawsuit filed by Gillen Washington, 23, who is suing the insurer for breach of contract and bad faith, saying he was denied coverage for an infusion of intravenous immunoglobulin (IVIG) when he was 19. His suit alleges Aetna's "reckless withholding of benefits almost killed him."
  Pages: 1 - 2 >>

Business Affairs Homepage


You Must Be Logged In To Post A Comment

Advertise
Increase Your
Brand Awareness
Auctions + Private Sales
Get The
Best Price
Buy Equipment/Parts
Find The
Lowest Price
Daily News
Read The
Latest News
Directory
Browse All
DOTmed Users
Ethics on DOTmed
View Our
Ethics Program
Gold Parts Vendor Program
Receive PH
Requests
Gold Service Dealer Program
Receive RFP/PS
Requests
Healthcare Providers
See all
HCP Tools
Jobs/Training
Find/Fill
A Job
Parts Hunter +EasyPay
Get Parts
Quotes
Recently Certified
View Recently
Certified Users
Recently Rated
View Recently
Certified Users
Rental Central
Rent Equipment
For Less
Sell Equipment/Parts
Get The
Most Money
Service Technicians Forum
Find Help
And Advice
Simple RFP
Get Equipment
Quotes
Virtual Trade Show
Find Service
For Equipment
Access and use of this site is subject to the terms and conditions of our LEGAL NOTICE & PRIVACY NOTICE
Property of and Proprietary to DOTmed.com, Inc. Copyright ©2001-2018 DOTmed.com, Inc.
ALL RIGHTS RESERVED