Mansell, Engel & Cole

Medical director's admission rocks insurance industry

A former medical director for one of the country's largest health insurers perhaps thought he was engaged in a rather run-of-the-mill deposition a while back in a matter concerning insurance denial for one policyholder.

Boy, was he wrong.

In fact, testimony given by ex-Aetna medical chief Dr. Jay Ken Iinuma is now having tsunami-like repercussions in the medical industry and bringing withering scrutiny from regulators in California, where the above-cited denial occurred.

Iinuma didn't say much, but what he imparted has been akin to an explosion. As a recent CNN article notes, the doctor admitted that as Aetna's top and ultimate care reviewer, "he never looked at patients' records when deciding whether to approve or deny care."

Moreover, he never consulted with doctors, opting instead to rely solely upon nurses' recommendation. Further still, he said he spoke with nurses concerning yes/no recommendations "zero to one" times a month.

Iinuma's statements are now being digested by medical professionals from coast to coast.. One prominent MD/professor calls them "incredible." Another terms them "a huge admission of fundamental immorality." Still another predicts that they could "reshape how insurance functions."

Aetna's official line stresses that the company -- which is the country's third-largest insurer, with more than 23 million policyholders -- has done nothing unethical and looks forward to responding to California's insurance commissioner.

Candidly, that seems hard to believe. Commissioner Dave Jones states that his now-alerted department will scrutinize every single Aetna care denial that occurred during Iinuma's nearly three-year tenure. Jones has further invited state residents having questions or concerns regarding the recent news to contact his office.

Hopefully his department is fully staffed. Given Aetna's huge size and high number of denials, the phones will certainly be ringing.

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