The Eye-Opening Investigation Into Insurance Giant Aetna

It’s a story we’ve heard told over and over again, but still, it remains a seemingly consistent worry in the minds of the insured.

All across the nation, upstanding and responsible individuals are paying their insurance premiums on time. They are working hard and making sure that they handle their financial obligations. Suddenly, tragedy strikes. An injury at work. An accident on the road. A  natural disaster that destroys their home.

It’s moments like this when they face some of their biggest challenges in life that they need support and protection the most. They turn to their insurer, expecting their company to be there. You should expect your insurer to honor their responsibility when you keep yours.

But that isn’t always the case, and a recent investigation into insurance giant Aetna proves just that.

Your bad faith insurance attorneys at Millin & Millin have represented hundreds of individuals and businesses confronted with their insurers acting in bad faith. When profit comes before a client, your team at Millin & Millin is there to make sure you obtain the benefits and compensation that are rightfully yours.

Insurance Company Aetna Fails Its Clients

In February 2018, a shocking discovery first reported by CNN revealed a 2016 videotaped deposition of Dr. Jay Ken Iinuma, former Medical Director for Aetna in Southern California from 2012 to 2015, admitting under oath that he never looked at patients’ medical records when deciding whether to deny or approve their coverage. Instead, Iimuma claimed that he was simply following Aetna’s protocols and was making his decisions based on what nurses recommended to him.

As the third-largest insurance company in the United States with over 23 million clients, this horrific admission has made quite a wave in the news and with lawmakers.

Iinuma made these statements in a courtroom appearance for a lawsuit filed by Gillen Washington in 2016. Washington sued the company because he was initially denied treatment for a rare immune disorder known as common variable immunodeficiency (CVID). Individuals who suffer from CVID are highly susceptible to infection and often deal with recurring health issues in the lungs, sinuses, and ears.

Washington, 23, sued for breach of contract and bad faith when he was denied coverage for the treatments needed when he was 19 years old. The company claimed that his bloodwork was outdated, and that his treatment wasn’t medically necessary. Without that treatment, Washington eventually suffered pneumonia and a collapsed lung while appealing Aetna’s decision.

Iinuma’s denial of coverage to clients like Washington without properly reviewing medical records is underscored by his admission to not knowing what plagued Washington as well as never having treated a patient dealing with the condition.

States and Federal Government Step In

A growing number of state and federal agencies have begun to investigate and request additional information to determine whether any laws were broken.

In the state of California, where the suit took place, two different agencies have begun to look into Aetna’s operations including the California Insurance Commissioner Dave Jones, who noted that the story was of “significant concern” to him. Considering that state law requires medical directors who are unqualified to review a patient’s case to seek consultation from another more qualified expert, the news of Iinuma’s action may prove to have been illegal. The California Medical Association and American Medical Association have shown similar concerns to Commissioner Jones.

Three other states have also begun their own investigation including Colorado, Washington, and Connecticut. Interestingly enough, Aetna is headquartered in Connecticut.

Now included in those state investigations, two Democratic senators have written a joint letter to current Aetna Chairman and CEO, Mark Bertolini. Ron Wyden of Oregon, ranking member of the Senate Finance Committee, and Patty Murray of Washington, ranking Member of Senate Health Committee, have requested for the company to release information related to their review process including “specific responsibilities of medical directors, nurses and chief medical officers, as well as any other company employees who are involved in such decisions.”

The senators also noted that, “In 2009, Aetna Health, Inc. and Aetna Life Insurance paid a $256,000 fine to Arizona insurance regulators for, among other things, denying health care provider payments without requesting additional information that could prove the claim valid.”

Sadly, this haunting truth isn’t the first time the insurance industry has been exposed for its seemingly rampant use of bad faith techniques and strategies to deny or underpay their clients. Thus far the company’s response has been that the testimony was “taken out of context”.

Don’t allow your insurance company to unlawfully deny your claim. Trust in the dedicated representation of your bad faith lawyers at Millin & Millin to provide the unique level of service you need to recover what is legally yours.

If you have any additional questions or simply need assistance with insurance claims and issues contact Millin & Millin at (956) 631-5600 to schedule a free case evaluation. Our compassion, dedication, and personal attention will get you the RESULTS you deserve.