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Senators Target Aetna's Review of Health Insurance Claims

Frankel & Newfield have battled Aetna and other disability insurance companies when claims have been denied with no apparent regard for the support provided in the claimants' medical records for years. Now it seems that two Senators, Ron Wyden, (Oregon-D) Ranking Member Senate Committee on Finance and Patty Murray (Washington-D) Ranking Member, Senate Committee on Health, Education, Labor and Pensions, are taking up the issue.

These two senators were troubled by a CNN news report on a medical director for Aetna who admitted that he was trained by Aetna in how to approve or deny care, and this training did not include looking at patients' records. This egregious admission has led to an investigation by the Insurance Commissioner of California, and now, the spotlight from two Senators.

Our own experiences with Aetna follow many of these same fact patterns:

  • Utilization of the same group of doctors who perform paper only peer reviews (courts have coined the term having "their bread buttered" by Aetna;
  • In-house medical and psychiatric resources to review claims;
  • Reliance upon vocational reports from Coventry Health, which is wholly-owned by Aetna;

The letter from the Senators, attached here, asks Aetna to provide a great deal of information about its claim approval process. While this case regards health insurance decisions, we believe that the training of medical directors and processes are much the same for disability insurance claims.

Could this signal a major change or merely a slap on the wrist for the giant insurance company? After all, we know that the insurance lobby is a power force on Capitol Hill, spending $160 million in 2017. That's a lot of influence and it is not done without impact. We'll keep you posted.

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