Intelligence

CA Investigating Aetna for Coverage Decisions

I’m seeking comment and analysis regarding how California’s health insurance regulators are investigating how Aetna makes health insurance coverage decisions. The investigations were prompted by the lawsuit of a California man who is suing Aetna for improper denial of care. Testimony indicates that the company’s medical director did not examine patients’ records before deciding whether to deny or approve care, relying instead on information provided by nurses who reviewed the records. I need attorneys or insurance industry analysts to address how common this practice might be, the legal implications, and any other related insights about how this case might affect Aetna and other health plans. I need written commentary or a short phone interview by Tuesday morning.