Aetna Medical Director Admits to Never Looking at Patient Records

2/12/18
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A former medical director at Aetna, Dr. Jay Ken Iinuma, admitted under oath that he never looked at patients’ records when deciding whether to approve or deny care. California Insurance Commissioner Dave Jones has launched an investigation and says his office is now looking into how widespread this practice is at Aetna. 

Dr. Iinuma said during the deposition that he was following Aetna protocol – to have nurses review records and make recommendations to him. Jones expressed concern, and noted that his expectation would be “that physicians would be reviewing treatment requests.”

“It’s hard to imagine that in the entire course of time, there weren’t any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional,” Jones told CNN.

The deposition by Dr. Jay Ken Iinuma is part of a lawsuit filed by Gillen Washington, a 23-year-old with common variable immunodeficiency, or CVID. Washington is suing Aetna for breach of contract and bad faith after being denied coverage for an infusion of intravenous immunoglobulin (IVG). His lawsuit states that Aetna’s “reckless withholding of benefits almost killed him.” Scott Glovsky is representing him.

Dr. Andrew Murphy, fellow of the American Academy of Allergy, Asthma and Immunology, underscores the importance of this investigation: “This is potentially a huge, huge story and quite frankly may reshape how insurance functions.”

For people with chronic conditions, such as Type 1 diabetes, battling denials of coverage from an insurance company is all too commonplace. The investigation launched by the California Insurance Commissioner may cut to the heart of the issue – who is making the decisions impacting patient access to care that may be life and death? And what information do they have about the impact of their decision? 


Read up on Navigating Insurance Denials + the full range of Beyond Type 1’s Access coverage. 


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