Insurance company arrogance is one big reason people are unhappy about health care
This commentary is a personal rant from the author and may not necessarily reflect the opinion of other authors at Box Turtle Bulletin. Additionally, it is not directly within the realm of what this site normally covers. I wrote it anyway. I make no claim that this is representative of anyone else's story, but it's mine.
January 29th, 2010
Most Americans have health insurance. And most Americans are content with their level of coverage. But “most” is not enough to quell the dissatisfaction that is growing in the nation over the way in which health issues are treated.
But unlike the politicians, I think the underlying discontent lies not in whether there is a single payer or whether catastrophic care is planned for or even in the increased cost of heath care. Rather, I think that the anger and frustration results from a total lack of control over ones own care coupled with the arrogance and condescension with which insurance companies treat the people who pay for their astronomic executive salaries and bonuses.
Allow me to illustrate.
I have pigmentary glaucoma. This is a rare genetic eye condition (discovered mostly in near-sighted male Caucasians in their 30s and 40s) in which bits of pigment flake off the iris and clog the eye’s drains. If untreated, the pressure in the eye builds, destroying the optic nerve and leading to blindness.
This is an easily treated disease. As long as I maintain a regimen of eye drops, I can keep the intraocular pressure in my eyes under control (below 21 mmHg) and avoid nerve damage. And although my eyes had reached pressures of 40 and 38 before detection, I have been very fortunate in that I have had very little loss of vision.
There are three different primary medications from which I can choose and, in the process of stabilizing my pressures, my doctor tried all of them. One was inadequately effective and one resulted in significant redness and irritation. But the third was, as Goldilocks might say, just right. (In conjunction with another eyedrop which works slightly differently)
So everything is just fine.
Until this week.
When I went to pick up my prescription I found that Aetna, my insurance provider, decided to move Travitan Z, one of my essential eye medications, off of their formulary list. What this means is that it is no longer covered at my standard deductible rate. In this case, the out-of-pocket monthly price of this medication went from $35 to $60.
Now moving a medication off the formulary list is not necessarily unreasonable. Sometime a generic is available, at other times there are comparable less expensive options that work identically. Unfortunately, this is not the case for me. There is no generic available and the alternatives were determined by my physician to be either less effective or a source of irritation.
So I called Aetna to discuss the situation. What I found was incompetence, arrogance, and condescension.
My first call resulted in a fellow telling me that he “went on Google” and found a generic, which would certainly have been fine with me. But after calling my pharmacy, I learned he had simply discovered the medication’s non-brand name but that this medication was not available as a generic drug and won’t be until 2013
The second call was when Aetna’s policy of deflecting criticism was revealed.
I was first told that the problem was due to my choices in the open enrollment period. So we walked through the options available that I so very foolishly ignored and, no surprise to me, in each option my eye coverage would be the same. Because the issue was not my “choices” at all, but rather that the drug had been moved off of the formulary list that was used for each of my options.
Having exhausted that avenue of blame, Aetna then told me, “that is the price at which your employer has chosen to cover that medication”. That, of course, was a flat out lie. My employer never said, “hmm, Travatan Z, yeah let’s raise the price on that”. Instead, my employer (or rather the large employment data processor that my real employer uses to process payroll benefits) set a rate for all non-formulary drugs and left the decision up to Aetna as to which drugs would be on the list.
The young lady to whom I was speaking then went for the “I didn’t decide that” route. Well, no, of course not.
But I wasn’t calling her to discuss my options, I was calling Aetna and she was just the voice of the company at that moment. But that simply generated another round of “well this is the result of your choices that you made during open enrollment and this is the amount your employer decided to pay for this drug”. It seems they trained her well; at no point did she acknowledge that the decision resulting in my increased co-pay was made by Aetna.
After finally having the young lady tell me that I had no options whatsoever, I thought for a moment about what I had hoped to achieve from my call. What could Aetna have done differently to avoid having me publicly vent my complaint?
- Aetna could have owned up to the responsibility of the decision that increased my monthly prescription budget. They could have explained the reasoning behind the decision and not tried to lie and claim that it was due to choices made by me or my employer. I might not have been happy, but I would not have felt manipulated.
- Aetna could have treated me like a client, someone that they want to retain and satisfy. They could have expressed concern rather than try to blame me and my employer for their decision.
- Aetna could have provided a means for which exceptions could be made. If there are adequate medications that provide alternatives to most glaucoma patients, that is fine. But some provision should be made for those for whom their doctor has determined that alternatives are inadequate.
- Aetna could have avoided the appearance of profiteering. I might be less resistant to paying an extra $300 per year if Aetna’s CEO was not paid in excess of twenty-four million dollars ($24,000,000) in 2008.
In summation, I’m screwed. Aetna made a decision and I get to pay for that choice. I can pay more with a smile, or I can pay more and vent my frustration to the entire world (clearly, I’m choosing the latter).
Now I know that I am fortunate. Even after the increase, I’ll likely pay less than $2,000 out of pocket for medical care this year. Some people face monthly prescription costs in excess of that amount. It hardly seems worthy of this rant.
But my experience with Aetna addresses a bigger issue.
I am, by nature, favorable to capitalism. I believe that a system that rewards investment and research is more likely than any other to result in continued improvements in treatment for my condition. But capitalism relies on competition, on the ability of the customer to pick up their custom and go to the store next door, which is not an option that many Americans have.
And I do not object to insurance companies making a profit. It is reasonable that providing a service should be compensated. But egregious salaries and bonuses secured through a political system that secures insurers’ advantages and disallows or discourages cross-state shopping or foreign nation pricing are offensive if not downright immoral.
So I have now joined the ranks of those who think of health insurance companies, Aetna in particular, with contempt. Not because of what they provide or really even the profit they make, but because of the limitations on choices that lobbying has created and the arrogance and contempt that it has bred within a smug corporate culture confident that it need not compete for my patronage.
And unless insurers want moderates and conservatives to join with more collective-minded Americans and seek to dismantle the entire system, they should seriously rethink their approach to business.
For those interested in the outcome, there may be a solution.
After ranting, I started searching the internet and Aetna’s own website and found that they had issued a Pharmacy Clinical Policy Bulletin which allowed for a medical exception specifically for glaucoma medicine if the patient was allergic to the one drug on their “preference list”. After reading this bulletin to Aetna’s employees, I was able to finally reach someone who was familiar with the exceptions that their customer service claimed did not exist.
After four calls from me (speaking to six different people) and two calls from my doctor, Aetna may be making a “tier override”. I’ve paid the larger co-pay but it looks like I may be refunded the difference.
But how many Aetna members do not have BTB readers to encourage them not to give up, are unskilled at searching, and are willing to believe what they are told by customer service? How many are just too sick to spend hours trying to resolve the problem?
Aetna should start caring about the concerns of their members. All the insurance companies should. In the current political culture, arrogance will not serve them well.