CNN’s Wayne Drash reported that in a recent deposition, Aetna’s former medical director for Southern California, Dr. Jay Ken Iinuma, admitted that he did not review medical records before denying requests to pre-authorize medical procedures. The case involves Aetna’s coverage denial for an infusion of intravenous immunoglobin. Rather than actually reviewing the records, CNN said the medical director testified that he relied upon the materials and suggestions provided to him by Aetna’s nurses when making coverage decisions.

Such irresponsible practices would not come as a surprise to us. The purpose of this article is to provide health care provider counsel with lessons and techniques to properly defend coverage and payment disputes with insurers.

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