Issue link: https://beckershealthcare.uberflip.com/i/976338
70 HEALTHCARE NEWS Aetna's former medical director says he never reviewed patient records before denying care By Ayla Ellison C alifornia's insurance commissioner is investigating Aetna aer one of the health insurer's former medi- cal directors admitted under oath he never reviewed patients' medical records when deciding whether to approve or deny claims, according to CNN. Jay Iinuma, MD, who served as medical direc- tor for Aetna for Southern California from March 2012 through February 2015, said in a 2016 deposition he followed Aetna's training by relying on recommendations from nurses when deciding whether to approve or deny care. California Insurance Commissioner Dave Jones expressed outrage aer recently read- ing the deposition transcript. "It's hard to imagine that in that entire course in time, there weren't any cases in which a decision about the denial of cover- age ought to have been made by someone trained as a physician, as opposed to some other licensed professional," he told CNN. "at's why we've contacted Aetna and asked that they provide us information about how they are making these claims decisions and why we've opened this inves- tigation." Dr. Iinuma's deposition came as part of a lawsuit filed by a 23-year-old college student, Gillen Washington. Mr. Wash- ington, who suffers from a rare immune disorder, sued Aetna for breach of contract and bad faith aer Aetna refused to cover an infusion of intravenous immunoglobulin when he was 19. He claims Aetna's "reckless withholding of benefits almost killed him," according to CNN. In response to CNN's questions, Aetna defended its practices and the coverage decision in Mr. Washington's case. "Medical directors — and all of our clini- cians — take their duties and responsibili- ties as medical professionals incredibly seri- ously," Aetna said in a statement to CNN. "Similar to most other clinical environ- ments, our medical directors work collab- oratively with our nurses who are involved in these cases and factor in their input as part of the decision-making process." n Woman receives $12k bill after 2-hour ER visit for bee sting By Ayla Ellison A woman in Florida received a $12,000 bill after she went to a hospital ED for a bee sting in 2015, according to CNN Money. After being stung by a bee in her yard in Valrico, Fla., Sylvia Rosas decided to go to the ED because she had experienced allergic reactions in the past, according to the report. While at the hospital, she was seen by numerous physicians, who ordered an EKG and thousands of dollars in blood tests. Her hospital visit lasted less than two hours. Because the hospital was not in Ms. Rosas' in- surance network, she was responsible for the entire $12,000 bill, according to the report. "Never did I think I'd have this type of a bill," Ms. Rosas told CNN Money. "I was there for such a short time." Ms. Rosas' experience highlights a national trend. 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