Aetna: Former medical director misrepresented our denial process

Aetna says comments a former medical director made under oath, which implied he never reviewed patients' medical records when deciding claim approvals or denials, are "a gross misrepresentation of how the process actually works."

The insurer's response comes days after CNN reported Jay Iinuma, MD, who served as medical director for Aetna for Southern California from March 2012 through February 2015, said in a 2016 deposition he followed Aetna's training by relying on recommendations from nurses when deciding whether to approve or deny care.

Dr. Iinuma's deposition occurred as part of a lawsuit filed by a 23-year-old college student, Gillen Washington. Mr. Washington, who suffers from a rare immune disorder, sued Aetna for breach of contract and bad faith after Aetna refused to cover an infusion of intravenous immunoglobulin when he was 19. He claims Aetna's "reckless withholding of benefits almost killed him," according to CNN.

Aetna says "Dr. Iinuma's deposition was taken out of context to create media and courtroom leverage" days before the trial was set to begin. Aetna added it "has paid for each and every treatment the individual suing Aetna has received since he first submitted a claim under his health plan in 2014. He remains an Aetna member today, and we continue to pay for his treatments. The only interruption in his treatment was the result of the individual defying his doctor's orders and refusing to provide necessary bloodwork. That is made clear in the CNN story."

California's insurance commissioner is investigating the insurer following the deposition. Colorado insurance officials are questioning the claims.

Ayla Ellison contributed to this article.

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