https://www.msn.com/en-us/news/us/state-...spartanntp
Hate to copy a CNN report, but:
An Aetna employee admitted under oath he never looked at medical records in determining whether or not to deny care.
I believe this and related decisions are a widespread problem in health insurance. The insurers commit fraud by making you fight to get what you paid for.
The issue here isnt the denial of care for this patient, as he wasnt denied coverage other than he refused to get bloodwork done that Aetna had requested, and waited so long (years) that when he needed the infusion he was in the hospital in terrible shape. (Again, due to the patients negligence, not Aetna.)
California may huff and puff about a physician not reviewing the medical records on denials, but if they didnt put that in the regulations, then Aetna isnt the only one who's not doing it. I love how the California insurance commisioner says it MAY BE a violation. The asshat who should know the regulations like the back of his hand IS THE COMMISSIONER. If he's saying it "MAY BE" a violation, then it sounds like it IS NOT a violation. This is the state's typical reaction when they get caught with a hole in their regulation, and try to point the finger at an insurer to cover their own butts.
Aetna obviously didn't do anything wrong.
muh single payer propaganda
Quote:Aetna initially paid for his treatments after each infusion, which can cost up to $20,000. But when Washington's clinic asked Aetna to pre-authorize a November 2014 infusion, Aetna says it was obligated to review his medical record. That's when it saw his last blood work had been done three years earlier for Kaiser.
Despite being told by his own doctor's office that he needed to come in for new blood work, Washington failed to do so for several months until he got so sick he ended up in the hospital with a collapsed lung.
Once his blood was tested, Aetna resumed covering his infusions and pre-certified him for a year. Despite that, according to Aetna, Washington continued to miss infusions.
Aetna tried to make him take a test for no reason. It was an effort to deny treatment. They make people jump through hoops in the hopes of outlasting them. That's the way they play the game.
Its not an argument for single payer. Its an argument for stricter enforcement of consumer protection laws. The health insurance companies have been caught in organized fraud (United healthcare and their fictional in house Reasonable and Customary). There just hasn't been any executives go to jail over it.
(02-12-2018 02:15 PM)bullet Wrote: [ -> ]Aetna tried to make him take a test for no reason.
No, they didn't. His blood work was 3 years old.