We told you about the California insurance commissioner’s investigation of Aetna after CNN reported that one of the insurer’s former medical directors testified that he didn’t look at patients’ medical records when making coverage decisions.
Yesterday, Aetna hit back with a statement saying the medical director’s deposition was taken out of context, and called it “a gross misrepresentation of how the process actually works.”
What’s new: The insurer cited a sworn statement by the former medical director, Dr. Jay Ken Iinuma, saying he reviewed “the relevant portions of submitted medical records” as well as “Aetna nurses’ summaries, notes, and the applicable Aetna Clinical Policy Bulletins” before deciding what treatments would be covered.
The big picture:
- Of course Aetna is fighting back — it’s under investigation, and a spokeswoman for California insurance commissioner Dave Jones says that hasn’t changed.
- But Aetna also argues that there’s a broader agenda at work. The company believes the deposition was used for “media and courtroom leverage” in a lawsuit against the company by a college student with an immune disorder who alleges that Aetna refused to pay for an infusion.
Between the lines: In his statement, Iinuma says he took the question about medical records to mean “the entirety of a patient historical file.” Per CNN, here’s how the exchange between the college student’s attorney and Iinuma went:
"Did you ever look at medical records?"
"No, I did not."