Cry me a freaking river, poor little Aetna just can't catch a break. Just when it looks forward to massive new profits in 2011, mean teaching hospitals at highly-respected universities ask the big-profit insurer to pay fair and reasonable rates for health care services provided to members.
Like any spoiled brat (and insurance companies that don't have to pay for the elderly, the poor, or the very sick -- Medicare, Medicaid and high-risk pools -- are indeed super spoiled), however, Aetna is threatening to take its ball and go home.
The problem, though, is that spoiled health insurance brats engaging in this kind of behavior don't just destroy pick-up basketball games on the driveway, they destroy lives -- and kill people. More below the fold.
The Charlotte Observer is reporting that Aetna is threatening to force all of its members out of UNC hospitals because of a fee dispute. Cancer patient Jean Holstein is one of those patients now battling not only a terrible disease, but, also, her mega-profits insurance company.
The last thing Jean Holstein needed as she faced eye surgery and ongoing chemotherapy for breast cancer was a battle with her insurance company.
But Holstein, along with thousands of others in the Triangle and beyond, was covered by Aetna, which last month was no longer accepted by UNC Health Care and its physicians because of a fee dispute.
Hurt most are patients like Holstein who have long-term needs for cancer, transplants and other complicated care. This group - an estimated 200 patients at UNC Hospitals in Chapel Hill and Rex Healthcare in Raleigh, which is owned by UNC - has been scrambling to get temporary reprieves to keep from switching their care.
But if the hospital and insurer don't resolve their differences, even these long-term patients are faced with finding new treatment teams at hospitals where Aetna still is accepted, or paying higher out-of-pocket expenses to stay in the UNC fold.
Now, let me be clear: insurance companies do play a role in keeping health care affordable. If it weren't for, gasp, mega-profits Aetna, hospitals could charge whatever they want to patients in the absence of national health care. Still, Aetna is most likely being entirely unreasonable here considering that its other motivation for reducing payments to hospitals is padding its profits -- and, thus, the salaries of its rich executives, like new CEO Mark Bertolini who the Hartford Courant says already has a mansion, hot tub and lots of wine.
Holstein says she can see through Aetna's "dispute" for its real motivations:
"People talk about the free market taking care of things, well, this is the free market," said Holstein, 54, who drives from her home in Jacksonville, N.C., to see her doctors in Chapel Hill.
She said she is ticked off at the insurance company, which posted a 34 percent rise in earnings last year, reaping $1.6billion. The company credited its fortunes to "management actions to appropriately price the business."
You see, bullshit like this "taking the ball and going home" business that Aetna is pulling in North Carolina is nothing for the rich, like Aetna executives, but it is big-time pain for people battling cancer and trying not to go bankrupt at the same time.
In an open letter to Ronald A. Williams, chairman of Aetna, Holstein calculated the cost of her care over the next 12 years as a fraction of his pay, which Forbes tabbed at $7.3million last year.
"Yet it would destroy all our carefully put away retirement savings," she wrote.
Holstein isn't the only person getting screwed by Aetna in North Carolina right now. The Hartford-based health and life insurer (and former insurer of slaves) recently put pregnant women through a ton of torture as well:
But some patients, like Jennifer Marks of Willow Springs, are caught in the middle. Marks is pregnant with her first child and is due in a little over a month.
While at Rex Healthcare last week for an ultrasound, she found out about the contract dispute and now faces finding another doctor and hospital with just weeks to go or having to pay as much as $13,000 because she would be using an out-of-network doctor and facility for her delivery.
Marks says she has asked Aetna for an exemption, but has not received an answer.
"It puts a damper on what's supposed to be a joyous time," Marks said. "We shouldn't have to worry about the expense and potentially switching doctors and hospital with only five weeks left."
Of course, Aetna took an ambivalent, uncaring, heartless, cruel -- well, normal mega-profits insurance company-style -- approach to helping these women -- demanding form after form and not responding -- until the media got involved:
Marks had filled out several forms with Aetna to make sure she wouldn't face extra charges at the facility and was told she would have an answer in seven to 10 days.
But Bruce Norman, an Aetna medical director based in North Carolina, called Marks on Monday to assure her that her coverage won't change.
"He apologized for the confusion" and mentioned seeing the N&O article, said Marks, who lives in Willow Springs. "I'm still dumbfounded."
Marks said she's relieved, but she still wonders why she had to go through the hassle of filling out and faxing forms to Aetna about her coverage.
"They're obviously still sorting through these transitions," she said. "If this is their policy, why wasn't I notified a few weeks ago? It doesn't make a lot of sense that they didn't notify the customer first."
As Wendell Potter says in Deadly Spin, "the squeaky wheel gets the grease in the managed care world."
It is shameful that the whole process of acquiring treatment amounts -- in the insanity that is a for-profit, corporate system of health financing -- to public relations brinkmanship rather than what is right for the patient.
We all know that stress is bad for health -- particularly when someone is fighting cancer -- so we can only hope and pray that Aetna stops abusing vulnerable patients in their time of need -- or karma will surely bite that company in the ass. (God forbid, the gold forks and spoons at the next corporate luncheon might have a smudge on them -- I suppose that's the "bad karma" you get in the corporate world.) Holstein, I think, has suffered enough without Aetna making things worse:
For Holstein, the ordeal of haggling with the insurer in the days leading up to her surgery took a toll.
"I was so angry dealing with insurance," she said. "There were other things I wanted to be doing, and I spent all my time worrying about that. It's infuriating. They're playing with people - playing with people's lives and money."
If you want to ask Aetna why it's not taking care of cancer patients and pregnant women in a respectful fashion, you may want to try calling or emailing here. Or, better yet, try investor relations at this link. That's the only department that really matters at Aetna, right? Me thinks if the pregnant woman described in this diary were an Aetna investor, she wouldn't have had to go to the media to get her baby delivered by a doctor she trusts. Or, perhaps, I'm just too cynical.
There is, of course, a way to avoid all this "insurance drama in the first place."
What system would avoid all of the following?
1.) A patient being forced to give up their doctor when fighting cancer.
2.) A patient being forced to give up their doctor when having a baby.
3.) Having to spend hours filling out forms while exhausted from chemotherapy medicines or late-term pregnancy.
4.) Having to spend hours on the phone talking to burned out call center employees and listen to horrible violin music.
Yup, you guessed it: single-payer Medicare for all.
Here's a way to cheer up after this depressing diary. Watch below and then contribute to California One Care, because if California goes single-payer, it's game over for Aetna, WellPoint, Humana, UnitedHealthcare, CIGNA or any other mega-profits insurer that acts with apathy towards the suffering of already suffering human beings.