Why should the practice of medicine inform medical care? (boldface mine):
California’s insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.
California Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna.
“If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California — and potentially a violation of law,” he said…
During the deposition, the doctor said he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.
Jones said his expectation would be “that physicians would be reviewing treatment authorization requests,” and that it’s troubling that “during the entire course of time he was employed at Aetna, he never once looked at patients’ medical records himself.”
“It’s hard to imagine that in that entire course in time, there weren’t any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional,” Jones told CNN.
Our healthcare debate (or whatever you want to call it) really isn’t about healthcare, it’s about healthcare insurance–how we will pay for it. But the actual delivery of healthcare–the stuff that makes you better–isn’t part of the discussion. And it should be.
Also, if you are still wondering why everyone, despite Paul Krugman’s exhortations, isn’t madly in love with the ACA, it’s crap like this that is the part of the reason why.