Aetna Starting to Send Patients to Mexican Hospitals to Save Money
Seen at Bloomberg:
Health insurers such as Health Net, Aetna Inc. and Blue Cross Blue Shield of South Carolina are offering cost savings to policy holders who take their ailing backs, hips and knees to foreign countries for non- emergency medical treatment. Mexico has emerged as a favored place for American medical tourists because of its proximity and U.S. insurer incentives.
Tags: Medical Tourism
One Issue With Aetna’s “Advantage” With SmartSource
You’ve likely heard a thing or two in the press about Aetna’s launch of SmartSource, Aetna’s response to Google’s and others’ attempts to create online patient-managed repositories of individual health records.
Silicon Alley Insider suggests that Aetna might have an advantage in this arena for one reason in particular:
But we think there’s some overlooked upside for Aetna here. According to this AP story, neither Microsoft nor Google is covered by the HIPAA, the federal law that protects the privacy of consumers’ medical records. The law creates standards of use for medical information and applies it to health plans, health care clearinghouses, and health care providers, among others.
That, of course, assumes that Aetna would actually heed HIPAA. My own claims nightmare might suggest that pesky legislation and regulation might only be heeded when there is a financial incentive to do so.
Tags: HIPAA, Privacy, SmartSource
Not All Errors Due to Insurers
Although it’s really tempting for me to blame certain health insurers (*cough* Aetna *cough*) for what ails the American health care system, insurance isn’t the only source of idiocy.
Consider, for example, this article in Insurance Journal:
The test involved the infusion of the amino acid arginine into his veins. His physician prescribed a dose of 5.75 grams, but the prescription processed by the Shands Medical Plaza’s outpatient pharmacy was 60 grams.
Hospital workers administered the dose, and did not realize the error even when the parents asked them to check their son, who developed a headache and appeared to be in extreme pain.
The parents took him home, but when he vomited and had seizures they brought him to the Shands AGH emergency room, where they waited four hours for the boy to be seen.
He was later sent to a pediatric intensive care unit, and a CT scan was misread because there was no pediatric radiologist on duty, the Ferreros said.
By the time he was transfered to the intensive care unit at Shands at the University of Florida, the boy was brain dead.
Let’s see…no one caught that the dose given was roughly 10 times what was prescribed, a sick kid is sent home from the hospital…and he waits four hours in the ER waiting room when brought back.
(I suppose that there is some small mercy in the four hour wait. My wife and I are used to 12-13 hour waits at our local ER when she’s in need of help.)
Tags: Medical Errors
New York Subpoenas Aetna and Others Over UCR Billing
I started this blog as a protest from having been screwed over by Aetna with some health insurance claims for my wife. It seems that New York is interested in how Aetna and other health insurers might be screwing patients over in the techniques they use to determine “usual, customary, and reasonable” rates of reimbursement.
From TrandingMarkets:
New York Attorney General Andrew Cuomo has issued new subpoenas to Aetna Inc. (NYSE: AET), Cigna Corp. (NYSE: CI), UnitedHealth Group Inc. (NYSE: UNH ) and WellPoint Inc. (NYSE: WLP), and other health insurers in a broadening investigation of possible fraud costing consumers hundreds of millions of dollars.[...]
Cuomo says he believes the companies used the UnitedHealth Group-owned Ingenix to set rates, which resulted in consumers being reimbursed at unfair and unjustifiably low rates. Low reimbursements mean higher out-of-pocket costs for consumers when they choose or need physicians outside their health plans.
Tags: New York, Usual Customary Reasonable
Class Action Suit Allowed Against Aetna Under ERISA
In my wife’s and my battle against Aetna, I had just about accepted ERISA as currently worded as being a “Get Out of Jail” card for administrators of employer-funded health plans. With a lack of punitive damages and no acceptance of bad faith as an argument against the TPA, there is no incentive for a health plan administrator to behave civilly towards plan members.
So, I was very surprised to see this article at TradingMarkets:
A class-action lawsuit over Aetna Inc.’s (AET) denial of coverage for people with eating disorders may proceed under the federal Employee Retirement Income Security Act of 1974, a New Jersey federal judge has ruled.[...]
Bruce Nagel, an attorney representing the plaintiffs, said the ruling is “significant because it is the first time in the country that a federal court has ruled that there was a bona fide claim and that the insurance company’s internal appeals procedure does not trump the claim.” Nagel said he will try the case to ensure coverage for hundreds of families with children suffering from eating disorders, such as anorexia and bulimia.
In favorable rulings for Aetna, however, Hochberg dismissed the plaintiffs’ claim under the New Jersey Mental Health Parity Law and their claims for punitive damages as pre-empted by ERISA. Attempts to get comment from Aetna were unsuccessful.
Tags: Class Action, Eating Disorders, ERISA
Aetna “Most Admired” ?!
I don’t know whether to take this as a sign that Fortune was deceived, or as a sign of just how sorry American health insurers are. From an Aetna press release:
Aetna Inc. (AET) today announced that it has been selected by FORTUNE Magazine as the most admired company in the Health Care: Insurance and Managed Care category for 2008. The publication ranks companies in various industry sectors in eight categories, according to their peers. Aetna achieved the highest overall ranking among its peers by placing first in people management, quality of management, quality of products/services and use of corporate assets.
Quote of the Day
Health insurers simply cannot hold out the promise of insurance for their consumers and then snatch it away just when people need it most. That is illegal, immoral and will not be tolerated.
That was uttered by California State Insurance Commissioner Steve Poizner, according to the Los Angeles Times, as feedback to word that a 52 year-old cancer patient had won a $9 million ruling, in arbitration no less, in the wake of having been dropped by her insurer, Health Net, part-way along in her course of chemotherapy.
That is, curiously, very similar to the experience my wife has had with Aetna (although they didn’t drop us…they just refused to pay the bills.)
Tags: California, Health Net
Aetna Wanted to Be a Pain in Your Ass
It seems that enough of a public uproar can cause even Aetna to back off from engaging in sadism. From the Wall Street Journal’s “Health Blog”:
Aetna’s backing off from its plan to refuse payment for an expensive form of anesthesia used during colonoscopies — at least for the moment.[...]
The things a corporation will do in the interest of making a buck, eh?
Tags: Anesthesia, Colonoscopy