Sens. Wyden, Murray Demand Answers From Aetna Over Denied Health Claims
WASHINGTON,
The letter (https://www.finance.senate.gov/imo/media/doc/022718%20Wyden%20Murray%20Letter%20Aetna.pdf) comes as the
"Using medical records is a fundamental responsibility of health insurers when they review health claims," Wyden said. "Something is gravely wrong if a leading insurance company is failing to use this basic information at the expense of families' health and peace of mind."
"It is completely unacceptable that a patient would have coverage for needed care wrongly denied, just because their insurance provider couldn't even bother to carefully review a claim--so I am hopeful we will receive a thorough and timely response from
The full letter can be found here (https://www.finance.senate.gov/imo/media/doc/022718%20Wyden%20Murray%20Letter%20Aetna.pdf) and below.
Chairman and Chief Executive Officer
Dear Mr. Bertolini:
We write to you in regards to recent news reports concerning
Most troubling was the description of
In addition,
The practices described by court documents and
In order to better understand the issues related to
1.
2. Please provide a description of the medical claims determination and patient appeal processes specific to
3. Please provide the total number of medical claims
4. Please provide (a) the total number of medical directors employed by
5. Please describe all duties and responsibilities of
6.
o Please provide guidelines and training materials that demonstrate how medical directors should communicate and consult with the nurse examiners.
o Please provide guidelines and training materials regarding how medical directors are expected to handle claims when they lack expertise about the condition.
o What is the process medical directors should use when the medical director lacks expertise with regard to a beneficiary's condition or treatment?
7.
8.
9. Court documents show that
o Does
o Please state how many claimant requests for denial letters
o Please also provide supporting documents related to
10. When benefits are denied because
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