Admittedly I’ve never been a C-level executive at an insurance provider, nor have I been employed as a claim adjuster for an insurance company. But it seems to me that even those of us who have never had to approve or deny health insurance claims know that someone charged with that great a task should be highly qualified. A recent CNN article sees insurance provider Aetna under intense scrutiny for admitting that their own medical directors don’t look at medical records when approving or denying a claim.
The story broke because a young man’s (who’s claim had been denied) lawsuit involved deposing the former medical director, revealing that Aetna’s practice is to have nurses provide details and recommendations to the decision makers, rather than have them look into each case themselves. The article goes on to describe how the director didn’t have any knowledge of the condition in which the young man suffered, and never looked into it. All the while, he still felt comfortable denying his claim (despite appeals from the man’s doctor, that the treatment was necessary for his survival).
You probably don’t need my soapbox speech about how scary this situation is, however I do feel that the story deserves recognition. It continues to shed light on how our tattered healthcare industry has continued to minimize the experience of the healthcare user, the person who’s life may depend on their care (and subsequent payment) from the large firm. They choose, instead, to place emphasis on the firm, corporate goals, and on commoditizing healthcare. While it may be true that having a nursing staff review medical records is efficient to meet goals, it is not efficient in providing quality healthcare.
Gillen Washington – behind Aetna’s Claim Denial
The industry is already known for its lack of transparency. It comes as no surprise to me that the person leading the charge in uncovering Aetna’s practices is only 23 years old. A millennial young enough to normally not have undergone any kind of invasive surgery at that point in his life, and should likely have never been denied his claim, may be responsible for changing the greater health insurance industry.
What do millennials have to do with it?
A recent article about marketing in healthcare explored a few ways in which the millennial generation is commonly misconstrued, especially by corporate giants like Aetna. And it shows an uncanny amount of parallels in how Aetna came to be under so much fire.
The article looks primarily at the following qualities and trends in how millennials view healthcare:
- They want to be engaged – the generation wants a 2 way street, they want to be heard and converse with their doctor to find solutions. Not to just show up, be told what the treatment is and go home.
- Millennials are researchers – They will spend time researching prices, procedures and ailments. They want to know what they’re up against in their treatment and be included in the conversation.
- They expect transparency – Being on the receiving end of a rough job market with high student loans will do this. Millennials want to know what the cost of their care is, and who it’s going to. Pure and simple. They’re good at researching and expect that prices should be available to them online.
What comes next?
It seems slightly odd that the two stories have come out within 24 hours of each other. But sometimes a story writes itself. I think that Aetna has demonstrated that they are the company that does things the old way. The business way. The way that got our healthcare to the place it’s currently in. A generation of healthcare consumers (essentially coming into the market for the first time, as they traditionally haven’t been “users” of healthcare at such a young age) that has different buying habits and demands will surely push the traditionalists to try a new way of doing business. A way that engages doctors with patients, and employees with their insurance plans.