Feb 12, 2018

Aetna under investigation after doctor says he didn't review claims

California Insurance Commissioner Dave Jones. Photo: Bryan Chan/Los Angeles Times via Getty Images

California Insurance Commissioner Dave Jones is investigating Aetna after one of the company’s former medical directors said he never reviewed patients’ information himself when deciding whether to approve claims, CNN reports.

Why it matters: Patients and doctors have long been frustrated with insurers' determinations about what's covered and what's medically necessary. Jones' investigation is centered on questions about how just how reliable insurers' processes really are.

The details: The Aetna doctor, Jay Ken Iinuma, said in a 2016 deposition that he relied on recommendations from nurses,

  • "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," Andrew Murphy, a fellow of the American Academy of Allergy, Asthma and Immunology, told CNN.

The other side: In response to CNN’s questions, Aetna defended both its handling of the individual case for which Iinuma was deposed and its broader practices.

  • "Medical directors — and all of our clinicians — take their duties and responsibilities as medical professionals incredibly seriously,” the company said. “Similar to most other clinical environments, our medical directors work collaboratively with our nurses who are involved in these cases and factor in their input as part of the decision-making process."

Go deeper

Trump hits back at Mattis: "I gave him a new life"

President Trump speaks at the White House. Photo: Doug Mills - Pool/Getty Images

President Trump unloaded on his former defense secretary via Twitter on Wednesday, hours after James Mattis condemned him for making a "mockery of our Constitution" in his response to mass protests in the wake of George Floyd's killing.

What he's saying: "Probably the only thing Barack Obama & I have in common is that we both had the honor of firing Jim Mattis, the world’s most overrated General. I asked for his letter of resignation, & felt great about it. His nickname was 'Chaos', which I didn’t like, & changed it to 'Mad Dog'"

Obama praises young protesters, urges mayors to pursue police reforms

Former President Barack Obama called on all mayors to review their use-of-force policies and commit to policing reform in a virtual town hall Wednesday hosted by the Obama Foundation's My Brothers Keepers Alliance.

Why it matters: Obama has addressed the killing of George Floyd and the nationwide protests that followed on social media and in a Medium post, but this was his first time speaking about the past week's events on camera. His voice will add weight to the growing pressure on local, state and federal officials to pursue policing reforms.

James Mattis condemns Trump as a threat to the Constitution

Mattis on Fox in Septemnber 2019 in New York City. Photo: Steven Ferdman/Getty Images

Former Secretary of Defense James Mattis condemned President Trump for making a "mockery of our Constitution" in a statement to The Atlantic on Wednesday, saying he was "appalled" at the president's response to mass protests in the wake of George Floyd's killing.

Why it matters: Trump’s former defense secretary had refrained from publicly criticizing his former boss since resigning in 2018.