Two leading Senate Democrats asked Aetna on Thursday to hand over information about its prior authorization process, citing concerns that their practices may have violated federal law.
Senate Finance Committee Ranking Democrat Ron Wyden of Oregon and Senate health committee Ranking Democrat Patty Murray of Washington honed in on California's investigation into the insurer's alleged refusal to pay for a critically ill patient's treatment without reviewing his medical history. A former Aetna medical director admitted during a deposition that he never reviewed patient medical records when deciding whether to pay for treatment.
The two lawmakers asked Aetna CEO Mark Bertolini to explain the insurer's claims determination and patient appeals process for its plans, as well as its medical directors' duties.
Wyden and Murray said Aetna's behavior in the California case "appears to violate safeguards put in place by the Affordable Care Act," which require insurers to allow beneficiaries to review their file.
The critique comes as congressional Democrats worry expansion of insurance plans that don't comply with Affordable Care Act coverage protections will lead to a higher number of similar cases. The Trump administration has lifted the time-limit on short-term plans, a move that critics say will pit these plans in direct competition with traditional insurance.
"These junk plans skirt key consumer protections included in the Affordable Care Act that bar insurance companies from ignoring appeals, denying care or charging people more because of their age, gender, or because of a pre-existing condition," the senators' release said.