Friday, March 09, 2007

An Open Letter To Aetna Health Insurance

Dear Aetna:

You suck.


Dear Aetna:

No, seriously, you suck.

Your friend,

Dear Aetna:

Do you have children? I am guessing that you do not. I am also guessing that everyone in your circle of family and friends and even passing acquaintances is exceptionally healthy, seldom falling prey to even so common an ailment as a cold. What leads me to this conclusion? Allow me to explain.

I have a son. Actually, I have two sons and two daughters. But for the purposes of this letter, let us say that I have a son with medical issues. He has Sotos syndrome, an overgrowth syndrome that is caused by a genetic mutation – a balanced translocation on his fifth chromosome, to be precise. Although all of the proper genetic material is there, he has a premature stop in the code, which means that the body simply stops reading the material after that point. The result is physical overgrowth (in other words, a child who is three years old, but the size of a robust 5-year-old) coupled with developmental delay (in other words, a child who acts younger than he is).

Until recently, I did not understand the significance of the terms developmental delay versus developmental disability. Did you know that a delay only becomes a disability at around school age? I am guessing that you did not. If you did know that, I would think that you would take every possible step to help treat a delay before it progresses to a disability. Make no mistake: taking action now, when my son is three, can have a profound effect on the rest of his life. Conversely, limited action in these critical years can have a profoundly devastating effect on the rest of my son’s life. But what do you know? You don’t even have any children.

My son received physical and occupational therapy via state-sponsored services from the time he was four months old. For nearly three years, he enjoyed services that you did not have to pay for AT ALL. Now that he is three, we are no longer eligible for those free services, and we need to move on to private therapy sessions. We have made arrangements for these services, and today the clinic called me.

“Were you aware that you have a $1000 deductible for these services?” asked the woman. “And that there is a LIFETIME cap of 60 sessions per diagnosis?”

I was stunned into silence, and you can ask my husband – that’s no small feat.

Now, granted, this level of coverage is because this provider is considered out of network. But why is that the case? Quite frankly, because the in-network rates you are offering to providers suck. In such a way as to make it financially not worthwhile for quality providers to sign up.

Be aware that by limiting my son’s ability to receive the services he needs, you are setting yourselves up to pay large amounts of money in the future.

Also, you suck.



Anonymous said...

I completely agree. Dont think another insurance company is better. We have Blue Cross Blue Shield and they deny almost every claim we send them. Then they raise our rates. It's infuriating.

Still just me said...

Be careful of the schools when your son is of school age also. My son who is now 16 had "delays" which were later labled "disabilites" in school. You will have IEP's and IEP meetings. Good luck finding a school who will actually follow the law and give your son everything he needs in order to learn.

Tuesday Girl said...

An insurance company insane? No!! Never!

Please, they all suck and all contradict what tehy cover and what they don't.