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Aetna demostrates insurance industry callousness about the medical needs of their “members”

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.

Timothy Kincaid

February 2nd, 2010

AetnaIn 2004 Aetna Insurance Company adopted the slogan, “We want you to know.” However, I really, really, truly, very much wish I knew nothing about Aetna.

As I wrote last Friday, Aetna, my HMO insurer, decided as of January 1, 2010 to move a medication that I require off of their preferred list. They do allow one other alternate medication, but I have an allergic reaction to that medication which results in redness and eye irritation and my ophthalmologist will not prescribe it.

In my update last Friday, I told you that it looked like a tier override might be possible. It is now clear that this was a misunderstanding. As I do not reside in New Jersey, such an option is not available.

During this process I discovered something interesting. Aetna has in place procedures to ensure that those who decide the pricing are shielded from all contact with those who suffer the consequences of their decisions. Even the intermediaries who speak with doctors are not allowed to talk to these decision makers, instead having all interaction be by means of forms and email.

Aetna wishes to make certain that those who deny coverage are not swayed by emotional appeal or the circumstances of any individual members. Were they to be made aware of the difficulties that they cause, they might be inclined to prioritize ethical practice ahead of gasp-worthy profits ($1.4 billion in 2008) and exorbitant executive salaries (which increased 625% between 2005 and 2008).

So Aetna wins. By taking my drug off the preference list, they will shift $25 per month from their bottom line to mine. And I have no recourse at all other than, of course, informing you, my Congressman, my Senators, my state legislators and the CA Insurance Commissioner of the practices of this corporation.

Comments

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Ray
February 2nd, 2010 | LINK

I certainly hope you HAVE informed the Insurance Commissioner. I think the IC is the place to start since advocacy is their freaking job!

Steve
February 2nd, 2010 | LINK

I share your anger with these behemoth insurance companies. I deal with them every day as a physician. So much for competition.
Please remember that one proposal in the new health plan was to subject these companies to anti-trust regulations just like other industries. That has fallen by the wayside. In my state, two major insurance companies control over 90% of the market. Good luck in trying to make a complaint to the insurance commissioner. I agree that their profits are obscene as are the salaries of these executives who are always trying to improve their “loss ratio”.

Also remember to thank smug Joe Lieberman who derailed any hope for reform when it comes to mega insurance companies. I hope he is sleeping well and enjoying the campaign contributions from major insurers in his state. He is a sanctimonious mealy mouthed politician who symbolizes arrogance, corruption, and the inability to get out of the grip of these special interests that are corrupting health care.

Finally, the drug companies are also to blame. The high prices of so many drugs are also obscene when you look at what others pay outside the U.S.. The endless TV ads for this drug or that and the creation of a perceived need to treat something with their drug is ridiculous. I am not suggesting that this applies to your eye. In general, this direct consumer advertising has driven up drug prices.

You might want to see if you could get the eye drops from Canada over the Internet if that is feasible. Some drops need to be refrigerated, so that might not work. Just a thought.

Timothy Kincaid
February 2nd, 2010 | LINK

Thanks, Steve.

But yes, Travatan Z is refrigerated.

wister
February 3rd, 2010 | LINK

While I share your indignation at least you’re not paying for your insurance yourself. Mine has gone from $2,000 a year in 01 to over $8,000 today. And then I have co-pays and drug costs on top of that. And no real long-term care provision.

Priya Lynn
February 3rd, 2010 | LINK

My sympathies go out to Americans who are forced to live on the edge of disaster because of privatized health care. It makes me so angry that Republicans stand in the way of health care for everyone for no rational reason – its just insane.

Andrew
February 3rd, 2010 | LINK

I share your indignation as well, and I know you know this, but keep in mind not only the millions of uninsured (which I’m sure you know), but the even larger numbers of the UNDERinsured. My employer just moved to a 3,000 deductible ($6k for family). Single parents working at this company are basically getting the price break associated with being a member of the covered group (up to 90% for some services — have you checked out the drop in price between what the lab wanted to charge you and what the insurance company allowed them to charge you????), but they aren’t really getting any financial coverage at all. And we’re lucky. Small businesses, with their smaller covered group, are routinely are subjected to >25% annual premium increases — we also lost a pension plan in order to accommodate the insurance plan we elected to keep.

But hey, I still have a job (and the benefits that come with it), so I’m still better off than a lot of people.

I guess my comment boils down to…

ARE YOU KIDDING ME? You’re on the Titanic and you’re complaining that the bartender spilled your drink.

C R
March 12th, 2010 | LINK

Tim:
Re: refrigeration requirement for your medicine:
Check with a pharmacist re refrigeration requirements for Travatan Z. It may not need refrigeration. True, it’s cousin medicine, Xalatan, does require refrigeration, but only UNTIL opening the bottle, not after.

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