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Are You Surprised? Breaking News from Aetna

February 12, 2018

Breaking news:  Former Aetna medical director for the insurer admitted under oath he never looked at patients' records when deciding whether to approve or deny care.

Are you surprised?

CNN quotes California’s Insurance Commissioner Dave Jones as saying, "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,"

How can anyone be surprised by this? Practicing physicians and their office staff deal with this every single day. This is a given. Insurance companies uniformly and repeatedly deny coverage without clinical information, even when the patient’s health is at stake. They hold the patient’s premiums and gain interest every day the funds are invested. Therefore the approach is to deny, deny, deny and hope either the patient or physician eventually gives up. Of course we do hope that with adequate persistence a medically trained human will eventually review the case and grant appropriate treatment.  But this is not the way any of us would hope to be treated.

The United States is the ONLY country in the world with a for-profit medical insurance industry. When you buy insurance, you are entering a contract with a company whose interests are diametrically opposite yours. You hope to use your premiums to maintain and/or improve your health. They hope to keep all your money. What do you expect?

Read the CNN article here »