Really, Aetna? This is Health Insurance?

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Since we moved back to the US from Turks and Caicos, I have been progressively disgusted by what passes for health care and health insurance here. It is truly upsetting.

Really, Aetna?

Uninsured in the Caribbean

When we first moved out of the US, we had no health insurance for about a year or two before National Health and a job with private health insurance, so we paid cash for everything. I can tell you that an Advair disc cost $125 retail outside of the US. Here, even with health insurance, we cannot afford the copay on Advair, and the "discounted" price is much more than $125.

Our doctors always gave a cash discount, and we were fine.

Under National Health, the Advair was $25. My mammogram was a $10 copay at the hospital. And when hubby had to be flown off to Miami for emergency care, the whole thing cost us that same $10 copay.

If a small Caribbean country can figure out how to pay for health care, why can't the US? We paid 4.6% out of our salary, and the company paid 5.4%  - NIH worked on 10% of people's pay, with the burden shared between employers and employees.

The Nightmare of US Healthcare

So, we moved back to NY in late 2011 and since then I have had, in four years, four different plans from two different insurers, United Healthcare and Aetna. Each year they cancel the particular plan that we have and we have to take a slightly different one, that pays for less with higher copays, and costs the same or more.

For over $1000/month for two people pre-tax, we have in network copays of $50 for primary care and $75 for specialists, plus a total deductible of $6000 and a total out of pocket max of $12000. So, for over $12000/year in premiums, we still have another $18000 we might have to spend, plus co-pays. And prescriptions.

Aetna Makes Mistakes and Profits

Today I discovered that this year Aetna doesn't fully cover breast ultrasounds. I have dense breasts, and routinely get an ultrasound at least ever other year to make sure I am clear.

This time, for the first time ever, I have a bill for over $300. Why? Because to Aetna an ultrasound is never routine, so it falls under my deductible. Really, Aetna?

So, while I was on the phone with Aetna, I decided to have the representative go through every claim. Well, there were six claims that they didn't pay that they should have covered in full. Of course, I already paid the providers for those, and now I have to try to get money back. Really, Aetna?

Could this be the reason for your 1 star consumer rating?

Paying for Chronic Illness

Now we have some new chronic illnesses in my house. We are looking at things like COPD, psoriatic arthritis, and autoimmune diseases.

All of these things will require multiple specialist visits, new medications and treatments, and tests. Hello, deductible and out of pocket expenses!

I don't know about you, but I don't have an extra $20,000 just laying around to spend on healthcare this year. That's why I have health insurance! I am close to the wire as it is.

This is an added expense that could break me. If you would like to help, please make a donation at my YouCaring page. Thanks so much!

Really, Aetna?