Department of Insurance in California Opens Investigation of Aetna

Jones said his office has'contacted Aetna and asked that they provide us information about how they are making these decisions

Jones said his office has'contacted Aetna and asked that they provide us information about how they are making these decisions

Aetna, the 3rd insurance company in the U.S., has been put under investigation by California Insurance Commissioner, Dave Jones after the former Aetna medical director declared that he was approving or denying care without studying the patients' dossiers.

This investigation was opened following the admission of Dr. Jay Ken Iinuma the former medical director in Southern California that he relied only on information given by nurses when he chose to give approval or deny a specific case, instead of reviewing the medical records provided to him. The California Department of Insurance could not be reached for comment Sunday evening.

The company said its medical directors are trained to review all available medical information, including patient records, to make decisions on coverage.

Jones told CNN: '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 coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional.

Dave Jones the Insurance Commissioner of California said his office was looking at how common a practice of defaulting to recommendations and reviews from nurses was in Aetna, which is the third largest USA insurance supplier. "That'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 investigation". The student, Gillen Washington, was denied coverage for an infusion of intravenous immunoglobulin, a treatment for an immune disorder from which he suffers. Aetna has rejected the allegations, arguing that Washington failed to comply with their requests for blood infusions. During his videotaped deposition in October 2016, he said he never read Washington's medical records and had little idea on how to treat it. He was not alone in his shock. with Dr. Arthur Caplan, founding director of the division of medical ethics at New York University Langone Medical Center, describing Iinuma's testimony as "a huge admission of fundamental immorality". "This reeks of indifference to patients", Caplan said, adding the testimony shows there "needs to be more transparency and accountability" from private, for-profit insurers in making these decisions.

In a statement to CNN, Aetna said it looks forward to explaining its clinical review process for California regulators. It said its medical directors take their responsibilities seriously but also "work collaboratively with our nurses".