Aetna prior-authorization practices come under lens as California begins probe - Sovereign Health Group
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02-21-18 Category: Mental Health

Aetna prior-authorization practices come under lens as California begins probe

Aetna’s prior-authorization practices have come under the lens after a former medical director of the insurance company admitted that he never reviewed patients’ medical records when deciding to approve or deny care. In the wake of such blatant violation of laws, California Insurance Commissioner Dave Jones said his department is probing into Aetna’s practices to understand why certain claims were denied and prior authorization was mandated for seeking care.

According to CNN, Dr. Jay Ken Iinuma, Aetna’s former medical director for Southern California, made the shocking admission during a deposition in a lawsuit filed against the third-largest insurer by 23-year-old Gillen Washington of Huntington Beach. Washington, who had common variable immune deficiency (CVID), was refused coverage for an infusion of intravenous immunoglobulin four years ago. Iinuma, who served for the insurer from March 2012 to February 2015, had said that he was guided by the nurses who used to review the records and make recommendations to him.

“If a health insurer is making decisions to deny coverage without a physician ever reviewing medical records that is a significant concern and could be a violation of the law,” Jones said. The shocking revelation has raked up a controversy concerning the transparency in the way insurers deal with the public when it comes to approval or denial of coverage, especially in the case of serious medical conditions. Expressing outrage over the fact that Iinuma lacked experience in treating autoimmune diseases, critics say that only an experienced doctor is capable of reviewing medical records before authorizing or refusing care for any disease.

Sadly, if this is the state of coverage for physical health condition, the plight of people with a mental health problem will be even worse, especially with all the associated stigma. Millions of Americans grapple with a variety of mental health issues, but the complex nature of these conditions stops them from being vocal about their problem due to the fear of being misinterpreted or scorned at. With limited access to specialty mental health care, lack of insurance coverage, and the stigma surrounding such conditions, many people fail to get treatment for mental disorders.

Mental disorders are treatable

Failing mental health is an ugly reality across the U.S. with more and more Americans falling prey to different psychiatric disorders than one can even imagine. According to the National Alliance on Mental Illness (NAMI), almost one in five adults in the country experiences mental illness in a given year. More shocking is the fact that less than half of the mentally ill individuals receive treatment for their condition.

Therefore, it becomes even more important to invest in a robust diagnosis to ascertain the root causes of a mental health problem and follow a systematic treatment plan at a reputed rehab to prevent the condition from snowballing into possible long-term complications. A qualified professional with the right experience and knowledge in mental health care is the best person to identify the external symptoms and recommend an appropriate recovery plan. After all, an expert’s opinion can be highly reassuring for someone fighting a mental health condition.

When wondering where to start with to find medical care for mental disorders, one needn’t look further than Sovereign Health’s mental health facilities in California that offer a variety of customized therapies for fast recovery. Specialists at our world-class mental health inpatient treatment centers are trained to identify the underlying causes and prescribe customized treatments as well as group psychotherapy based on a patient’s requirements. You may call our 24/7 helpline or chat online with one of our counselors for more information about our evidence-based treatment programs.

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