Aetna Investigation of Jay Ken Iinuma, MD, broadens

[drusso]

Is Evicore next?

Aetna inquiry widens over ex-medical director's comments - CNN

During his videotaped deposition in October 2016, Iinuma acknowledged more than once that he did not look at medical records, saying he was following Aetna's training, in which nurses reviewed records and made recommendations to him. "How would you decide on your own when to actually review the medical records versus relying on what the nurse at Aetna had prepared for you?" asked Scott Glovsky, an attorney representing the patient suing Aetna.

"What percentage?" Iinuma asked.

Glovsky: "I mean, like, did you ever look at medical records or basically whenever --"

Iinuma: "No, I did not."

Glovsky: "OK. So as part of your custom and practice in making decisions, you would rely on what the nurse had prepared for you?"

Iinuma: "Correct."

Glovsky: "Instead of actually looking at yourself the medical records?"

Iinuma: "Correct."

Glovsky: "And was that throughout your -- your years at Aetna?"

Iinuma: "My tenure, yes."

Glovsky: "Was that how you were trained to do it when you joined -- first joined Aetna?"

Iinuma: "To my recollection, yes."

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[Aether2000]

Insurance practices in general should be investigated by Congress, and laws passed to stop this kind of corporate defrauding of policyholders who pay thousands to tens of thousands each year to these corporate bandits.

 

[newbie04]

Deny. Deny. Deny.

I do every peer-to-peer out of principle and our patients deserve an appropriate work up / procedure, etc.

This week I was on the phone for >5hrs for approval of an MRI of the pelvis.

Denied right after ordering without peer to peer.

Submitted my note and denied again without peer to peer.

Asked to speak to Medical Director of the insurance company and was told that it was denied twice; thus, I could only “discuss the case but no decision would be made to overturn the case.”

I was pissed to say the least and laid into this clown. MRI was finally approved.

I hope these jackasses go down hard.


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[hyperalgesia]

It would be interesting to have a law that requires insurance companies to only deal directly with patients or their POA.

Docs provide the pt with the script for the study or procedure we are ordering and they have to present it directly to their insurance if they want it to get paid for. Insurance says, "You have to complete this paperwork and submit these forms", etc. If a pt says, "Can't my doctor do this?", insurance replies, "The law requires that we receive this directly from you." Denials go directly and only to the patient/POA.

It's crazy how it is now because docs are a buffer and pts don't even know how crooked their insurance is. They just see the nice ads on TV.

 

[Ducttape]

what should be done is that there should be a 3rd party arbitrator that decides on what an insurance company will pay for.

how corrupt is insurance industry? asking for someone in the same company that denied a claim always is obviously so clearly biased for the company, that someone is paying money to...

 

[jettavr6]

Insurance practices in general should be investigated by Congress, and laws passed to stop this kind of corporate defrauding of policyholders who pay thousands to tens of thousands each year to these corporate bandits.

Important question: Who owns congress?

 

[Ducttape]

Big Pharma and NRA.

That was easy. Next question?

 

[jettavr6]

Big Pharma and NRA.

That was easy. Next question?

Missed a couple -- Hospitals and Insurance!

 

[geauxg8rs]

Missed a couple -- Hospitals and Insurance!

And trial lawyers

 

[craigkes]

Is Evicore next?

Aetna inquiry widens over ex-medical director's comments - CNN

During his videotaped deposition in October 2016, Iinuma acknowledged more than once that he did not look at medical records, saying he was following Aetna's training, in which nurses reviewed records and made recommendations to him. "How would you decide on your own when to actually review the medical records versus relying on what the nurse at Aetna had prepared for you?" asked Scott Glovsky, an attorney representing the patient suing Aetna.

"What percentage?" Iinuma asked.

Glovsky: "I mean, like, did you ever look at medical records or basically whenever --"

Iinuma: "No, I did not."

Glovsky: "OK. So as part of your custom and practice in making decisions, you would rely on what the nurse had prepared for you?"

Iinuma: "Correct."

Glovsky: "Instead of actually looking at yourself the medical records?"

Iinuma: "Correct."

Glovsky: "And was that throughout your -- your years at Aetna?"

Iinuma: "My tenure, yes."

Glovsky: "Was that how you were trained to do it when you joined -- first joined Aetna?"

Iinuma: "To my recollection, yes."

Evicore is horrible..... The docs are just as bad. Had a doc actually tell me that he didn't know any of the guidelines he was spouting off to me... "the insurance company just gives them to me". I can only hope it gets back to them

 

[drusso]

Evicore is horrible..... The docs are just as bad. Had a doc actually tell me that he didn't know any of the guidelines he was spouting off to me... "the insurance company just gives them to me". I can only hope it gets back to them

It is not only Aetna, but every major health insurer.

 

[IN2B8R]

Yes; all politicians are in the pockets of these insurance companies—precisely why doctors and, ultimately, patients get screwed.


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