Skip to main content

Aetna Under Investigation by California Insurance Regulators

Aetna is currently being investigated by the California Dept of Managed Healthcare (DMHC) and the California Dept of Insurance (DOI) in relation to recent testimony in a lawsuit.

"The Department of Managed Health Care, which regulates the vast majority of health plans in California, said Monday it will investigate Aetna after CNN first reported Sunday that one of the Hartford, Conn., company's medical directors had testified in a deposition related to the lawsuit that he did not examine patients' records before deciding whether to deny or approve care. Rather, he relied on information provided by nurses who reviewed the records — and that was how he was trained by the company, he said."


"In an emailed statement Monday, Aetna did not directly address the question of case reviews by non-physicians. It said its "medical directors review all necessary available medical information for cases that they are asked to evaluate. That is how they are trained, as physicians and as Aetna employees." It added, "adherence to those guidelines, which are based on health outcomes and not financial considerations, is an integral part of their yearly review process."


Read the full LA Times Article 


Dave
www.davefluker.com



Comments

Popular posts from this blog

Anthem Blue Cross (CA) Adding SilverSneakers® Fitness Program

Anthem Blue Cross (CA) announced this morning that they will be adding the SilverSneakers Fitness Program to California Medicare Supplement Plans A, F, and N.  The added benefit will begin on January 1st, 2017. 

Once approved for release into the market, more states have been added to the list as existing and new members in our marketed plans will enjoy the value-added benefits of the SilverSneakers Fitness program at no additional cost! Effective January 1, 2017, California members in our marketed plans will enjoy SilverSneakers, too.  The program offers members their choice of paths to better health. For those who enjoy a traditional workout setting, SilverSneakers offers access to more than 13,000 fitness locations across the country, including use of classes and guidance from a Program AdvisorTM. In addition, for those who can’t get to a fitness center, SilverSneakers Steps® kits focus on at-home or on-the-go general fitness, walking, strength training or yoga. And if that is not …

Anthem Blue Cross Announces Innovative F Medicare Supplement Plan for CA

Anthem Blue Cross (CA) has announced that they are releasing a new Medicare Supplement (Medigap) Plan for California residents.  The plan will be available beginning January 1st, 2018.

'Innovative F' will offer benefits not covered by a Medicare Supplement base plan.  These will include a hearing benefit (exam, fitting and allowance) and a vision benefit (exam, lens co-pay and allowances for frames and contact lenses).

Anthem states that the Innovative F will have a very competitive premium rate.  Innovative F will include the Silver Sneakers fitness program and will be eligible for the Plan F 'new to Medicare' $20 per month first year discount.  

http://www.davefluker.com/innovative-f-supplement.html



Dave
www.davefluker.com





Innovative F Health Net Medicare Supplement Launches August 1st in California

Health Net of California has announced the rollout of a new Medicare Supplement Plan.  

Available beginning with August 1 start dates, Health Net will offer their Innovative F Supplement in California.  Earlier this year, Anthem Blue Cross introduced their Innovative F plan.  Health Net's plan marks the second "Innovative" Medicare Supplement in California.

One huge difference between the two Innovative F plans--unlike Anthem's plan, Health Net's Innovative F is available to upgrade from your Plan F to Innovative Plan F during California's "Birthday Rule" Guarantee Issue Period.   Health Net considers Innovative Plan F an "equal benefit" plan compared to Plan F.

Health Net Innovative F offers additional hearing and vision benefits that include:


Routine Hearing Exam - One Hearing Exam every 12 monthsHearing Aid(s) - includes fitting evaluation. $1000 benefit maximum for two hearing aids (one pair) or $500 for one hearing aidRo…