Preston Wood is an RN Case Manager at a large acute care hospital in Los Angeles.
The real truth about predatory practices in the billion dollar insurance business broke out this week when the former Medical Director of insurance giant AETNA admitted under oath that he “never looked at patients’ records when deciding whether to approve or deny care.”
This comes just when AETNA and Pharm giant CVS are looking to merge, creating one of the largest healthcare monopolies in capitalist history. When corporate giants such as these two entities are allowed to merge, it only increases the stranglehold of the billionaire class on the health and welfare of workers and their families.
These are not mom and pop operations. Aetna’s strong second-quarter performance resulted in net income of $822 million and adjusted earnings of $2.1 billion for the six months ended June 30, 2017.
This exposé of rampant greed resulting in unimaginable suffering among people coping with life threatening illnesses came about as the result of a lawsuit filed by an AETNA patient, Gillen Washington, who asserts that the company failed to cover treatments for a rare immune disorder.
Two California state agencies, investigating Aetna’s conduct, have found that Aetna’s process involved denying treatments without medical review, as required by law. In a deposition by Dr. Jay Ken Iiuma, a former Medical Director of Aetna for Southern California he admitted he signed the denial for patient Washington’s treatment without reading the patient’s medical records, and admitted knowing nothing the about immune disorder of the patient. This amounts to criminal disregard, putting the life of the patient at risk!
In his testimony, the former Medical Director stated that he had minimal if any knowledge of the medical condition Common Variable Immune Deficiency that the patient Washington suffered from. He also admitted that he had no idea about what the most effective drug would be to treat the patient’s condition, the symptoms of the disease, or the consequences of abruptly discontinuing therapy for the condition. “Do I know what happens?” Iiuma said. “Again, I’m not sure… I don’t treat that.” When asked if it was his general practice to look at medical records as part of the decision process, he declared it was not.
According to Shana Alex Charles, a professor who studies insurance at California State University Fullerton, California state law said of the law: “If the medical director is not qualified to review a case because of lack of specific knowledge in that medical discipline, then the law requires a consultation with an expert in the field. ” Charles added, “Clearly an investigation is needed to determine the full extent of how many provisions were broken and what the consequences should be.”
Why is there insurance? Why isn’t all healthcare free on demand for everyone?
The concept of insurance is a capitalist-created way of making sure that profits are protected. The giant insurance companies reap billions of dollars in profits by scrutinizing all procedures, all medications and all medical equipment requests in order to find ways to deny, deny and deny services.
Denying and refusing to authorize needed care is a billion dollar heist off the backs of working people, leaving millions in pain, facing bankruptcy and homelessness. The main cause of bankruptcy in the United States is draconian medical bills for what should be free to all. Every day, thousands of requests from case managers and health care providers are denied all across the United States. These are not just computer files, they represent people who need and deserve medical care.
Corporate thieves such as Aetna must be brought down, arrested and jailed for their brutal acts of denying healthcare to those in need.