Cost of Being Underinsured: His Right ArmGo to Top
That was the banner on a column in yesterday's Philadelphia Inquirer. The columnist wrote about a guy who has Aetna coverage. Aetna told him it was sending a man to the rehab to fit him with a prosthesis,i.e., his right arm. He had been preapproved, but was subsequently informed that he had coverage for only $2,000 for artificial limbs. However, Aetna informed him that the arm he received cost more like $37,000. He had been told by the company supplying the limb that his $530 a month premium entitled him to the prosthetic. Aetna dispatched the company furnishing the arm to retrieve it, which it did. He then started making calls to his girlfriend, to an aunt, to his lawyer. The prosthesis supplier even called Aetna. After much prodding, Aetna relented and he got his artificial limb back. An Aetna spokesman stated it was a miscommunication and they (Aetna) had mistakenly considered his new arm medical equipment rather than a prosthetic which is covered in full. Aetna called him to apologize.
Re: Cost of Being Underinsured: His Right ArmGo to Top
Now, is it just me, or does the $37K for a piece of plastic shaped in the form of an arm seem just a tad high?
Seriously, what is the cost of making these things?
The other part of the story, not told, is the company who sent in the bill probably coded it as medical equipment, not a prosthetic, which is what triggered the problem in the first place. Computers only do what you tell them to, not what you want them to do.
Re: Cost of Being Underinsured: His Right ArmGo to Top
The article doesn't go into much detail, but does mention that this prosthesis would permit him to use the artificial hand to pick up things. Apparently, it is a state of the art item and not just a piece of plastic molded in the shape of an arm.
Re: Cost of Being Underinsured: His Right ArmGo to Top
Personally, I would have taken off the arm and beaten up the Aetna rep. As for the cost, I'd imagine that the price of the arm is a reflection of the supply/demand of that particular product in the market.
The good news is that I just found out that Maryland does have a mandate for hair prostheses, so John P. has hope. Unfortunately, that procedure is limited to $350 and can only be covered as a result of hair loss due to chemotherapy or radiation treatment for cancer. So, it looks like he'll just have to find a discount card program.
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"Tell me and I will forget. Show me and I will remember. Involve me and I will understand." Confucius
Re: Cost of Being Underinsured: His Right ArmGo to Top
Thats just bullshit insurance backpedaling right thar... ...I believe the term that is written in most insurance policy's is "durable medical equipment " and I would think a artificial arm IS durable medical equipment .....that is one of the reasons I have a prob. with the UC saver plan because it does not cover durable medical equipment and was told not only did it include crutches and oxygen bottles but also PACE MAKERS.......needles to say........
Originally Posted by arnguy
An Aetna spokesman stated it was a miscommunication and they (Aetna) had mistakenly considered his new arm medical equipment rather than a prosthetic which is covered in full. Aetna called him to apologize.
Re: Cost of Being Underinsured: His Right ArmGo to Top
The article is a great way though to show clients the importance of not having caps on an insurance plan, especially considering the other options up in PA.
Re: Cost of Being Underinsured: His Right ArmGo to Top
The bottom line is if his policy only covered $2000 then that is the policy. He didn't read his policy? Imagine that?
The only way to prevent this "whole" is a state mandate.
Should an individual company cover his fake arm? Is that also reasonable? I am not siding one way or the other.
The bottom line is every plan every one of us sell has multiple holes one way or the other. There is no perfect plan - and let's not forget about the worst plan of all - the one that is so expensive no one buys it.
I can pick apart Assurant, GR, Humana - you name it, they are all written in virtually a foreign language - I would have to spend a week with my Attorney and even then we wouldn't figure it out.
Again it goes back to STANDARDIZED individual plans such as A to Z, it really is a great idea to help the consumer know what MINIMUM coverages they are buying. I am not saying mandate standardization, but make it optional.
Let the industry step op and self regulate, before big brother does.
Re: Cost of Being Underinsured: His Right ArmGo to Top
The bottom line is every plan every one of us sell has multiple holes one way or the other. There is no perfect plan - and let's not forget about the worst plan of all - the one that is so expensive no one buys it.
Okay, I'll bite, what expensive plan are you alluding to?
Again it goes back to STANDARDIZED individual plans such as A to Z, it really is a great idea to help the consumer know what MINIMUM coverages they are buying. I am not saying mandate standardization, but make it optional.
No argument there. People have the misconception that you cannot put a price on life. Unfortunately, you can and have to due to the population growth, economy and advances in technology.
100+ years ago people thought that you should drain your blood in order to rid yourself of an ailment. Now, we have the ability to log onto a website, type in some information and BAM, Mr. Customer, we expect you live until your 73. It's amazing how far we've come in the last 100 years.
Re: Cost of Being Underinsured: His Right ArmGo to Top
Haha....the point is all policy's have their limits and as an agent its your responsibility to look at every angle to help get your clients claims payed....just this last year I had a client that had a heart attack and the $1,200 ambulance was processed out of network so he called me on what to do.....I told him to call the company and ask what ambulance service was in his network....he calls back and says they told him none.....soooooo....I told him to send in a appeal for this claim that you have in network ambulance coverage but was told no one contracted for the services you are charging me for....and the fact that it was a life and death situation and it is in your policy that if you can not reasonably make it to a network provider that the out of network charge should be counted as a in network claim..they did as he requested and said he sure knew alot about his policy.....smartass's...
Originally Posted by salpro22
I don't see the difference here in your comment or mine, since they're the same thing.
Re: Cost of Being Underinsured: His Right ArmGo to Top
Originally Posted by somarco
Let me see if I got this straight.
Aetna used a repo man to take back his arm?
No, it wasn't a repo guy. It was the guy from the prosthesis supplier who initially fitted his arm. According to the article, the guy was embarrassed and upset that he had to reclaim the artificial arm. Also, he was the one who contacted Aetna to lodge a complaint.
Cost of Being Underinsured: His Right Arm
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