California launches investigation following stunning admission by Aetna medical director
Source: CNN
California's insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients' records when deciding whether to approve or deny care.
California Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna.
"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 said.
(snip)
Iinuma said he never looked at a patient's medical records while at Aetna. He says that was Aetna protocol and that he based his decision off "pertinent information" provided to him by a nurse.
(end snip)
Read more: http://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html
Explosive testimony. And, I suspect, widespread practice. I hope they look at how the doctors and nurses are paid by Aetna, for example, bonuses.
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of the medical insurance industry. Veterans who get emergency treatment at a non VA hospital are often denied payment by a reviewer who is not even in the medical field.
I was hospitalized after a car accident for what eventually turned out to be three weeks.
But I'd initially been discharged after one week, once the insurance company decided I no longer needed to be in the hospital - over the strenuous objections of my doctor.
I'd broken my leg in 22 places, requiring two surgeries to put it back together, had broken several ribs, and was covered in bruises from head to toe.
I was getting Dilauded several times a day because the pain was excruciating, and Soma to help me sleep.
The insurance company discharged me to a nursing home, where I spent one night, and they gave me one Vicodin.
My husband said I begged him not to leave me there. (I don't even remember that.)
When they came in the next morning, I was hooked over the edge of the bed (the beds were not adjustable) and crying in my sleep.
My father-in-law, bless him, drove over to the hospital, put his wallet on the counter, and said, "What do I need to do to get her back in here?"
By the time they brought me back to the hospital, I was having terrible drug withdrawal symptoms, in addition to the unbearable pain from my leg.
I ended up spending two more weeks there, during which time I was better able to recover.
As it turns out, my husband's insurance carrier had recently switched providers.
There was a 6-month period where they received hundreds of complaints, and so they switched back - but I'd been caught in the middle of that.
It was unreal.
(And insurance did wind up covering most of the costs... eventually. I guess I was lucky to be hurt and unemployed, so I had plenty of time to spend on paperwork.) 
What an awful thing to go through only to have to wonder abt. the insurance after living through such an trauma!
Has your leg healed up or will it ever?
This is just one sad example of why healthcare should be a #1 priority for need of a huge fix!
Take care in the meantime!
And yes, after a year of drugs & physical therapy, I got my leg back to about 95%.
There's always a dull ache, and it hurts when the weather changes, but at least I'm walking. 
Because the rich can afford it that is why. The rest of us just sit on the sidelines and hope it seems to me.
I have a rich sorta relative. Doesn't like generic Norcos & demands brand-name only. Gets exactly what is wanted as said person is a member of the #1 and can pay for it easily. Why don't they look at this type of opiate abuse ... and yes it is just that as there is no real clear DX showing need. They need not worry though. 
And I don't hear any talk abt. drug testing said person either, nope. 
