Aetna Medical Director Routinely Denied Care Without Looking at Patient Records

Yesterday, February 11th, CNN broke an astonishing story: “California launches investigation following stunning admission by Aetna medical director.” The news exclusive highlighted a recent trial where a former medical director of Aetna, Dr. Jay Ken Iinuma, “admitted under oath [that] he never looked at patients’ records when deciding whether to approve or deny care.” Aetna is the third biggest health insurance carrier in the United States, serving over 23 million paying customers.

Dr. Iinuma has defended his actions as standard procedure that follows Aetna’s training. Nurses are tasked with reviewing patient files and providing summaries that are used to make decisions to deny or approve benefits. Dr. Iinuma stated that the bulk of his work was conducted online, and while he could call a nurse to request additional details or insight on a patient’s records, he did this between “zero to one” times a month.

“This is potentially a huge, huge story and quite frankly may reshape how insurance functions,” said Dr. Andrew Murphy, a peer of Dr. Iinuma who is a renowned fellow recent board member of the American Academy of Allergy, Asthma and Immunology.”

California Insurance Commissioner Dave Jones was outraged at the testimony, and has begun an immediate investigation into Aetna’s review practices. He stated, “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 urges California residents who may have been impacted by Aetna to contact him immediately.

What can you do to protect your rights?

There is no way of knowing how wide-spread these “clinical review” procedures are. No matter where you live, or who your insurance carrier is, you must ACT NOW.

  • Contact your local legislator and make sure they are aware of this story
    • Find your elected officials’ contact information here (enter your zip code and click “Submit” for a full list including phone and web contacts).
    • Demand your state’s Insurance Commissioner and Attorney General investigate IMMEDIATELY

We must make our voices heard. These outrageous practices must be stopped. Stand up for your rights TODAY.

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