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Stunning Admission By Aetna Healthcare Director Reveals He Didn’t Look at Medical Records Before Denying Payment for Life-Saving Medical Care


Aetna Healthcare Director Denies Claims Without Medical RecordsMedical care is an essential part of any properly functioning society. Accidents happen, people get hurt, others get sick —  for these reasons and more, the need for acceptable and affordable medical care is always prominent.

When people suffer from severe illnesses or diseases that require treatment, the costs of such treatment is often very high. That is why medical insurance and healthcare coverage has become such a critical component in giving people the capability to be covered for tough medical and financial situations.

Unfortunately, improper practices by insurance providers and medical professionals alike can lead to the deprivation of life-saving treatments that people depend on.

A recent CNN exclusive report was the first to shed light on this grievous reality when it released a detailed account of a former medical director for Aetna admitting under oath to making decisions about whether to approve or deny healthcare coverage without ever reviewing patient medical records.

In the article, it states that the former medical director maintains that he was only following the training protocols put in place by Aetna, in a process by which he claims nurses reviewed patient records and then made recommendations based on those records, which they then relayed to him. Under oath, the medical director explained how he “never once looked at patients’ medical records himself.”

This stunning admission took place during a deposition for another lawsuit being filed against Aetna. The lawsuit involves a college student who is suing for breach of contract and bad faith after being denied coverage for an infusion of intravenous immunoglobulin (IVIG). Aetna had previously supplied benefits to cover the costs of other IVIG treatments but stopped, saying they needed new blood work done. The student’s infusions ran about $20,000 each.

CNN reports that the medical director’s admission regarding the regular practice of approving or denying healthcare coverage without personally consulting a patient’s medical records has been called “a huge admission of fundamental immorality” by Dr. Arthur Caplan. The founding director of the division of medical ethics at New York University Langone Medical Center states further in the article that “people desperate for care expect at least a fair review by the payer. This reeks of indifference to patients.”

It seems that Dr. Caplan’s sentiment is one that many are inclined to agree with. People in need of medical care deserve a timely and reasonable evaluation of their medical history, as well as their current medical needs. It should be standard procedure that a medical director considers every possible factor of the patient before deciding on the best course of action moving forward. So when an insurance company wrongfully denies insurance claims or delays resolution in the hope that a policyholder will just give up, these are common examples of bad faith on the part of the insurance company.

Skilled Litigation Lawyers Serving People Dealing With Insurance DisputesThroughout Jefferson County & Beyond

This type of indifference toward patients is exactly why the esteemed attorneys at Johnstone Carroll, LLC put their years of dedication and hard work into every case by helping individuals dealing with insurance disputes  in both personal and commercial lines. If you are in an insurance dispute over the amount of policy coverage or compensation you are entitled to for a claim, contact our lawyers today. We are ready to help you recover the full amount of money or insurance coverage you are entitled to under your policy.

Contact our office at 205-383-1809 to set up a free consultation and begin discussing your legal options.

The articles on this blog are for informative purposes only and are no substitute for legal advice or an attorney/client relationship. If you are seeking legal advice, please contact our law firm directly.