Posted by: yourhealthradio | March 10, 2011

A Modern Health Care David vs. Goliath

The letter below came to YOUR HEALTH from Jean Holstein, an unfortunate and courageous North Carolinian who is suffering not just from Cancer, but by a fight with Aetna, who cannot reach an agreement with UNC Health Care to continue providing health insurance to patients. We discussed this issue on this week’s YOUR HEALTH radio show, and Jean’s story was also featured on the front page of the News and Observer this past week.

This highlights some of the issues all of us could face. Let us hope this gets resolved promptly for ALL patients.

February 20, 2011

An open letter to:
Mr. Ronald A. Williams, Chairman of Aetna, Inc.
151 Farmington Avenue
Hartford, CT 06156

Dear Mr. Williams,

I applaud your efforts as Aetna CEO to make health care more accessible and affordable for all Americans. Furthermore, your company must be doing something right to have generated more than $34.6 billion in 2009. Wow — quite a feat in a downturned economy. However, I think you should know about some lingering issues with the “accessible/affordable” part of your efforts.

I have stage IV breast cancer and, since 2002, have been treated at The University of North Carolina Hospitals. Even when we moved nearly three hours away from Chapel Hill — a move required to find employment that offered health insurance — we still travel to UNC for my cancer care.

In November 2010 we were offered the choice of switching to Aetna from Blue Cross/Blue Shield during the open enrollment period. I carefully perused the options, and after ensuring all our health-care providers were in your network, we chose Aetna. Besides having breast cancer, which requires monthly treatments and tri-annual X-rays and other scans, my right eye has a malignant tumor that is scheduled to be surgically removed at the end of February. Five weeks after our coverage started with Aetna, I was informed your company no longer includes UNC Hospitals or their physicians as in-network providers. Not only does this change triple our co-payments, but it also now requires me to pay the entire costs out-of-pocket while waiting until my submitted charges are approved for reimbursement, at whatever rate your company decides is appropriate. With my upcoming surgery, two treatments and scans, we would have to pay more than $36,000 between February 16 and March 16. With approximately $5,000 every month for future treatments also requiring upfront payment, the total comes to more than our gross income for all of 2011.

Mr. Williams, unlike you, most Americans don’t make $18 million a year. If I were to continue to have the same treatments at the same costs and lived another 12 years, which is questionable, the complete cost of all my remaining care would add up to only one-eighteenth of your 2009 salary — but it would gobble just about every dollar we have. My husband has worked hard his entire life. We pay off our credit cards each month. We were diligent about putting money away for our children’s education and for our retirement. We purchased a house we could afford, and we have considered ourselves to be very responsible– even conservative — in our financial lives.
But that isn’t even the worst part.

I wasn’t informed until February 2 — just two weeks before I was scheduled for treatments, scans, and surgery — of Aetna’s complete deadlock with the UNC Healthcare systems. The UNC Hospital staff person who called was very distressed on my behalf, and was in fact hoping that the negotiators would reach an agreement before the February 5 deadline. Is it true that Aetna wants to reimburse UNC less than other insurance companies pay and less than Aetna pays other similar providers? As it is now, insurance companies make deals way below the actual cost of the services– who pays the difference?

I found out, on my own, that I could apply for Transition of Coverage that would let me continue with treatment already underway, for a limited period of time. Please understand that I am dealing with a terminal illness and preparing to have something cut out of my eye besides the normal challenges of everyday life. Instead of dealing with my physical and emotional needs, I had to spend the time searching the Web for the appropriate forms, fill them out and send them to my medical provider. Additionally, my doctor had to take time from her busy schedule to fill in her parts and fax the forms to Aetna. A couple of days before my cancer treatment appointment, I called Aetna to see if I had been approved. After “talking” to the phone system robot and tearfully pleading to speak to a live person, I was transferred several times until I was finally told that my request could not be found. I spent most of that day in tears trying to find out what I needed to do. Finally I called my doctor’s assistant, who offered to make more calls for me and was able to solve the puzzle.

Two days later, while in an infusion room awaiting my cancer treatment, I received a call from my doctor’s office telling me I had been approved for 90 days of in-network coverage. I was relieved! But, three days later, I received a letter saying that approval was only for this particular doctor and treatment; it did not cover surgery or my eye surgeon, or the scheduled scans that will show if my cancer is holding steady or spreading. Although my request for the eye surgery was submitted at the same time as my oncologist’s request, I had not heard if it was accepted or even located, and now I had to scramble to submit one for the X-ray exams — I’m still waiting and hoping those costs will be approved. What will happen after 90 days? I’ll have to worry about that after I recover from my surgery. Unfortunately, we cannot change to another insurance provider until next January. However, switching from UNC is not an option, I’ve been with the same oncologist for eight years and I literally trust her with my life.

Filling out forms and making multiple calls to a phone center is frustrating and stressful for anyone, but even more so while undergoing difficult treatments. I have been told that, as a cancer patient, I need to keep my stress level low and take care of myself. I wonder if this “run around” from Aetna is a ploy — as one former congressman stated – to “get me to die quickly.” That would cut your costs and increase your profit because my husband and his employer would continue to pay the insurance premium — wouldn’t it? Salaries and bonuses come from making a profit, don’t they? On Aetna’s web site, your bio states: “Mr. Williams served as both Chairman and CEO of Aetna from 2006 to 2010. Under his leadership, Aetna has sought to make a positive impact on health care in America by serving as a catalyst for change, focusing the industry, public policy leaders, physicians and employers on issues aimed at increasing access and affordability.”

Thousands of Aetna clients like myself, clients who depend on the UNC Healthcare system are finding that health care is no longer accessible or affordable. Would you say your work for change has been successful? If not, please explain how you earned huge bonuses when you haven’t met your expressed job performance goals?


Jean Holstein

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