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Aetna, CIGNA Receive Failing Grade In Spitzer SurveyFrom: rmodugno@aol.comWed Mar 31 11:28:05 2004
This story was sent to you by: Robert Modugno MD Go get 'em, Elliot!
>From ctnow.com By DIANE LEVICK Courant Staff Writer March 31, 2004 Aetna, CIGNA and other health insurers got an F on Tuesday from New York Attorney General Elliot Spitzer in a survey of how well the companies disclosed what care they would pay for. A unit of Spitzer's office used surveyors, posing as consumers, to send letters to 22 companies selling health insurance to individuals in New York. The letters asked for clinical review criteria that each company would use to determine whether certain care would be covered for specific medical conditions. New York's Managed Care Consumer Bill of Rights requires such information to be provided, on written request, to members or prospective members. Each plan received five requests, and then received a grade from A to F based on the number of satisfactory responses received. For instance, a B was given for three satisfactory responses, and an F for no satisfactory responses. Eleven health insurers got an F, including Aetna, CIGNA, Health Net, and WellCare of New York, the "report card" shows. Seven companies, including Oxford Health Plans, got a D for each giving only one satisfactory response, the report says. Only one health plan - Empire HealthChoice - got a B, and no company received an A. Aetna spokesman David W. Carter said his company will "look forward to learning more about the details of his survey and resolving any misconceptions." "At Aetna, providing information to consumers and enabling them to make informed decisions is an important part of how we do business," Carter said. In the survey, each health insurer was asked for review criteria on whether they'd cover an insulin pump for diabetes, surgery for Crohn's disease, arthroscopic knee surgery, nutritional supplements, and breast reduction surgery. Letters have been sent to each company detailing violations of the disclosure law and requesting compliance, the report says. The law doesn't provide for specific penalties, so legislation has been proposed to create them, the report adds. Copyright 2004, Hartford Courant -------------------- Visit www.ctnow.com for Connecticut news updates, sports stories, entertainment listings and classifieds. --------------------
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