CNN just ran an incredible story by Wayne Drash (see it here) on a health insurance claim denial by one of the country’s largest insurers, Aetna. The story involved the case of Gillen Washington, a 23-year-old Californian, who is represented by attorney Scott Glovsky. Apparently, Aetna denied medical treatment to Gillen based on the opinion of an Aetna-employed doctor who had not even read the medical records on Gillen. In fact, the Aetna doctor testified in his deposition that as a matter of practice in his job reviewing policyholders’ claims at Aetna, he never reviewed the medical records of the policyholders. Mr. Glovsky brought a lawsuit on Gillen’s behalf, and it is set to go to trial this week.
Now, the Insurance Commissioner in the State of California has opened an investigation into Aetna’s claim-handling practices. The commissioner expressed concern over the Aetna doctor’s testimony and apparently intends to look into the matter. Aetna denies any wrongdoing.
The CNN story quoted Dr. Arthur Caplan, founding director of the division of medical ethics at New York University Langone Medical Center, as describing Aetna doctor’s testimony as “a huge admission of fundamental immorality. People desperate for care expect at least a fair review by the payer. This reeks of indifference to patients.” CNN also quoted Dr. Caplan saying the the testimony shows there “needs to be more transparency and accountability” from private, for-profit insurers in making these decisions.