https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html
Though the individual case may or may not be defensible, Aetna has managed to bring every single state and federal regulatory authority to examine all of their pre-authorization/claim denial practices into focus.
If I were a practicing physician, I would the revelations infuriating when someone who doesn't have the training and expertise make 'recommendations' and the physician a. not having the medical record and b. not have the expertise (via specialty) to make an informed decision. This in turn translates to wasted time/resources to 'educate' or appeal to the insurance company. Don't see a way the Feds are not going to hold up the Aetna/CVS merger until investigations are completed by the states, plus CVS would now get Aetna at a discount if they don't walk away entirely.
Though the individual case may or may not be defensible, Aetna has managed to bring every single state and federal regulatory authority to examine all of their pre-authorization/claim denial practices into focus.
If I were a practicing physician, I would the revelations infuriating when someone who doesn't have the training and expertise make 'recommendations' and the physician a. not having the medical record and b. not have the expertise (via specialty) to make an informed decision. This in turn translates to wasted time/resources to 'educate' or appeal to the insurance company. Don't see a way the Feds are not going to hold up the Aetna/CVS merger until investigations are completed by the states, plus CVS would now get Aetna at a discount if they don't walk away entirely.
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