Senate Democrats demand answers from Aetna CEO on insurer's claims review process

Two Democratic senators inked a letter to Aetna CEO Mark Bertolini requesting the insurer answer questions about why a former medical director said he never looked at patients' medical records when deciding to review or deny claims, CNN reports.

In the Feb. 27 letter, Sen. Ron Wyden, D-Ore., a ranking member of the Senate Finance Committee, and Patty Murray, D-Wash., a ranking member of the Senate Health Committee, said the former medical director's comments raise several red flags. 

"Using medical records is a fundamental responsibility of health insurers when they review health claims," Sen. Wyden told CNN. "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."

The senators requested answers to 10 questions by March 20. Aetna told CNN it looks "forward to responding to Senators Murray and Wyden, and will do so before their deadline."

Last month, Jay Iinuma, MD, who served as medical director for Aetna for Southern California from March 2012 through February 2015, said in a 2016 deposition he followed Aetna's training by relying on recommendations from nurses when deciding whether to approve or deny care. Colorado, Washington and Connecticut have joined California in investigating Aetna over the comments, which Aetna previously called "a gross misrepresentation of how the process actually works."

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