Not All Errors Due to Insurers
Posted on March 13, 2008
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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
Posted on March 12, 2008
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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
Posted on March 11, 2008
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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” ?!
Posted on March 7, 2008
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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
Posted on March 4, 2008
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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
Posted on March 3, 2008
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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
Health Insurance Doesn’t Prevent Medical Bankruptcy
Posted on February 29, 2008
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A sobering statement I found in the Austin Statesman:
Most people who file for bankruptcy because of medical bills are middle class, according to Baumer and others. The Harvard study, published by the journal Health Affairs, said three-fourths of those who filed had insurance at the onset of their illness.
Even so, co-pays, premiums and prescription expenses can overwhelm a patient or family, said Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard Medical School. Serious illness can also lead to job loss, and with it can go the health insurance, he said.
That doesn’t quite match the reality I’m writing from (I’m thankfully employed at a good job; it’s my wife who’s disable). I can’t help but wonder how many other folks are struggling because a health insurer has reneged on its promise to pay the medical bills.
The article also makes a passing reference to one other unpleasant reality my wife and I became acquainted with in the wake of her disability:
Ann Davis, who also is uninsured, worked three jobs while her husband tried to get on disability and a government-financed health insurance program to cover a liver transplant.
In my wife’s case, it wasn’t until a few days after the fifth anniversary of the incident that caused her to be disabled that she received her first SSDI check and Medicare card.
When the financial planners emphasize the need to build up an emergency fund (and to purchase long-term disability coverage), in case you have to be on your own, without income, without insurance, after a disability…they aren’t kidding!
Tags: Bankruptcy, Social Security Disability
DNA Testing and the Fear of the Health Insurers
Posted on February 28, 2008
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I realize that this site is titled “Aetna Sucks”, but part of what I’m hoping to do here is to highlight some of the ways that America’s health care system is truly effed up.
The health care market is one in which patients are afraid of being screwed over by their insurers, patients are afraid of what their doctors might disclose to the insurance companies, and health insurance underwriters seek to find any reason to get off a high risk.
Consider, for example, a story which appeared in Sunday’s New York Times on the subject of DNA testing:
The first, much-anticipated benefits of personalized medicine are being lost or diluted for many Americans who are too afraid that genetic information may be used against them to take advantage of its growing availability.
In some cases, doctors say, patients who could make more informed health care decisions if they learned whether they had inherited an elevated risk of diseases like breast and colon cancer refuse to do so because of the potentially dire economic consequences.
Others enter a kind of genetic underground, spending hundreds or thousands of dollars of their own money for DNA tests that an insurer would otherwise cover, so as to avoid scrutiny. Those who do find out they are likely or certain to develop a particular genetic condition often beg doctors not to mention it in their records.
Tags: DNA Testing
Hartford Protest Against Aetna
Posted on February 23, 2008
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I’m still playing with some of the "behind the scenes" work on getting the site up and appropriately indexed. However, while I fiddle, and in lieu of earth-shattering new content… A couple of weeks ago, CT News Junkie reported on a small protest outside Aetna’s home office in Hartford, to "celebrate" the announcement of a very profitable 2007 for Aetna. They posted this video, for those of us who couldn’t make it:
Tags: Aetna, Hartford, Protest
Coming Soon….
Posted on February 19, 2008
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This site is still under construction.
However, please watch this space for the story of my adventures in resolving a claim dispute with Aetna, and other associated rants.
And, of course, it goes without saying that this is a personal website. In no way shape or form is it associated or affiliated with Aetna or its subsidiaries.
Tags: Meta