BOSTON (CBS) – Few people wield more power over our lives than the administrators at health insurance companies, especially the doctors charged with approving or denying patient care claims.
If they say no, you’re out of luck, and luck is what you’ll need to reverse their often life-affecting rulings.
So it’s especially disturbing to learn from a CNN report about the work habits of a former medical director for insurance giant Aetna in California.
Dr. Jay Innuma made a startling confession under oath in a lawsuit filed by a patient who claims Aetna unfairly denied him crucial treatment for a serious immune deficiency.
“Did you ever look at medical records?” he was asked.
“No, I did not.”
Instead, Dr. Innuma claims he relied on the accounts of nurses who reviewed the records, but the top state regulator says that’s not good enough.
“If a 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,” California Insurance Commissioner Dave Jones told CNN.
In a statement Aetna claims their “medical directors are trained to review all available medical information – including medical records – to make an informed decision” and “take their duties and responsibilities as medical professionals incredibly seriously.”
But not, allegedly, and by the doctor’s own account, in this case.
And in how many others?
This is the kind of story that makes you wonder – how many other corporations with life and death responsibilities are blowing them off so casually?