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May 02, 2019

Aetna Settlement In Civil Suit Involving Controversial Coverage Denial

Aetna reached a confidential settlement with the plaintiff on the eve of trial in the case of Gillen Washington v. Aetna.  The lawsuit asserted claims for insurance bad faith and breach of contract, after Aetna denied a request for pre-authorization for critical treatment for defendant's rare autoimmune disease.  Washington’s condition worsened following the denial, raising important questions about pre-authorization issues.  The case drew media attention following the deposition of Aetna’s medical director, which was characterized as containing an admission that he had not read Washington’s medical records prior to denying the request for pre-authorization; Aetna asserted that the medical director’s comments were mischaracterized.  An investigation by California’s insurance authority followed.