Forum

Insurance Business forum is the place for positive industry interaction and welcomes your professional and informed opinion.

Notify me of new replies via email
Insurance Business | 12 Feb 2018, 09:19 AM Agree 0
He admitted ignoring patients’ records when making care decisions
  • K.S. | 12 Feb 2018, 11:49 AM Agree 0
    As a breast cancer survivor with Aetna insurance this was not surprising. Aetna refused to pay for scans such as mammagram for remaining breast and colonoscopy, using the diagnostic not preventative loophole although I have been no evidence of disease for 5 years. I still don’t understand the industry’s adversion to logical preventative medicine, especially when the cost of treatment is so high.
  • stephenjbarbe | 12 Feb 2018, 12:55 PM Agree 0
    A prime example as to why to not go with "Medicare Advantage" because of the "Medicare dis-Advantage", (pun intended). Medicare Supplement also known as Medigap plans is the way to GO!
  • Bruce | 12 Feb 2018, 02:20 PM Agree 0
    I did not see a mention of Medicare Advantage coverage here and assumed it was referring to a major medical policy. Please explain where you saw different information especially since the patient was 19 years old. Also such a blanket statement illustrates a shallow knowledge of how these products work. For some people Medicare Advantage plans are very good options. There is not one plan good for all people.
    • stephenjbarbe | 12 Feb 2018, 05:07 PM Agree 0
      My Bad. I missed the 19-year-old age of the patient. Thanks for the notice. I still do not recommend nor care for Medicare Advantage though.
  • SMS | 13 Feb 2018, 11:07 AM Agree 0
    Both a major medical policy or a Medicare Advantage could be affected by this type of violation of policies & procedures as they all have prior authorization rules in place. A Medicare Supplement pays and follows the guidelines of Medicare, not their own internal policies, so in that regard they would provide less risk for these types of coverage denials. However, as Bruce states, not all policies are appropriate for all patients and not all patients can afford the Medicare Supplement policies. And someone on Medicare due to disability at any age, would be eligible for the Medicare Advantage options. We should not be so quick to dictate what policy is 'better' than another or more appropriate to someone in a different medical situation. And I don't believe this is an isolated case, either by Aetna or any other carrier. I have experienced the long and frightful process of attempting to fight the insurance on a denial of care and know many others who have had to fight the same fight. IMO, the bottom line, regardless of your healthcare coverage, the decision for all medical care should be made by educated medical professionals who take the time to review the individual situation. When the profits of the insurance company come before the medical needs of the patients they serve it is time to make some serious changes.
Post a reply