It could be that you aren’t being covered for your health conditions by your insurance company simply because a doctor isn’t actually reviewing your case, on the insurer’s end.
So, health insurance: any conversation on the topic has the potential to open up a big pot of worms.
Last weekend, CNN took a can opener to an even larger issue. If you haven’t heard of the Aetna scandal yet, read on.
Here it is. It all started with a court case, involving the plaintiff Gillen Washington, who is suing Aetna for breach of contract and bad faith. He says he was denied insurance coverage by the company for an infusion of intravenous immunoglobulin (IVIG) back when he was 19 years old.
Washington suffers from a rare immune disorder called common variable immunodeficiency, or CVID. He says that Aetna’s refusal to cover him at the time was reckless and almost resulted in his death.
And it gets worse. The thing is, during the trial, Aetna’s former medical director revealed that he never once looked at patients’ records when making the decision to approve or deny their medical care. The company’s policy, he says, was different. He was told to rely on information provided by a nurse, and that was it. No further research, no doctor’s assessment, nothing.
Sounds bad? Yes. Upon learning this, CNN naturally felt something was wrong. The media outlet took the court transcript from the trial and presented it to California’s insurance, commissioner, Dave Jones, who expressed his disbelief.
Jones then began an investigation into Aetna’s practices.
For its part, Aetna apparently has told CNN that it looked forward to “explaining (their) clinical review process” to the commissioner.
What stories will be told? And how widespread is this practice within the medical insurance industry in the U.S? We may be about to catch a glimpse.
“This is something that all of us have long suspected,” Dr. Andrew Murphy, who runs an allergy and immunology practice west of Philadelphia, told CNN, “but to actually have an Aetna medical director admit he hasn’t even looked at medical records, that’s not good.”
No, not good at all. For the moment we’ll just have to wait and see what’s next…and pop some popcorn for what may be a long show
Photo credits: Casimiro PT/Shutterstock.com