Insurance Regulators Investigating Aetna for Training Employees to Deny Coverage Without Reviewing Patient’s Medical Records

Aetna, the country’s third largest health insurer, is under investigation by state insurance regulators following Aetna’s admission that it routinely denies medical treatment coverage without reviewing the insured’s medical records. Aetna’s admission surfaced in a lawsuit by a California man who claimed Aetna improperly denied coverage for his medical treatment. The insured has a rare …

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New ERISA Rule Restores Important Rights to Insureds

For insureds, ERISA (which governs most employer-sponsored insurance) has a serious downside.  Insureds and plan participants who dispute the company’s denial of their claims for coverage or benefits must submit to ERISA’s administrative appeal process before they can file a lawsuit challenging the company’s decision.  This can disadvantage the participant because failure to dot i’s …

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Can the ERISA Plan Deny Coverage Because you Made a Technical Mistake When Enrolling?

So you sign up for insurance through your employer.  The HR people say "yup, you're signed up all right!"  You pay premiums for a few years.  Then, you make a claim and the insurance company says you're not covered - turns out, you filled out the paperwork wrong when you signed up for coverage. Can …

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Plain language: What’s this ERISA thing and why should I care?

Most non-lawyers go through their lives never having heard of ERISA until one day they get a letter from their insurer saying their treatment isn't covered or their claim is being denied and that they have a certain number of days to exercise their rights under ERISA.  For most folks, insurance and an ERISA plan …

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