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Aetna forms review board
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January 12, 1999: 12:00 p.m. ET
Move will allow denied patients to appeal to panel of outside experts
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NEW YORK (CNNfn) - Aetna U.S. Healthcare announced plans Tuesday to become the first national managed healthcare organization to voluntarily provide external review of coverage decisions.
Aetna U.S. Healthcare, the health business unit of Aetna Inc. (AET), plans to have the program in place for all Aetna U.S. Healthcare commercial HMO and related health plans members in states not already covered by external review laws by June 30.
Aetna U.S. Healthcare currently offers members internal review coverage decisions. The expanded policy will permit members to request external reviews after the first- and second-level internal appeals have been completed.
"If a neutral expert sees things differently than we do, we want to know in real time so that swift action may be taken," said David F. Simon, chief legal officer, Aetna U.S. Healthcare, in a statement. "Delays serve no one's interests, and this review policy enables rapid response to our members' concerns."
External reviews will be decided in 60 days. Expedited reviews will be available when a member's life, health, or ability to regain maximum function would be in jeopardy.
Aetna will bear the cost of independent reviews, except in states which require a filing fee.
Aetna was down 1/8 at 89-3/4 in recent trading.
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