Ruth Kaufman - Award-Winning Author and Romance Writer

Ruth Kaufman is the author of My Life as a Star, My Life as an Extra, My Once & Future Love, The Bride Tournament, Follow Your Heart, At His Command and other books.

Healthcare Cost- Take 2

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Will new healthcare laws really help those who don’t have insurance?  How about those, such as myself, who pay hundreds of dollars every month but still have high deductibles?  Those who have insurance, but often when we need something, it might not be covered at all, much less fully covered?

For example, an online chat with customer service confirmed that Aetna covers a “routine” colonoscopy at age 50.  They don’t cover any pathology charges.  Who knows before taking the test if ours will be routine?  Whether there’ll be additional charges, or how much they’ll be? 

Also, Aetna won’t cover the full cost of the prep my doctor chose. With it, patients drink a lot less bad-tasting liquid can choose among assorted clear liquids for most of it.  Apparently I’m fortunate that they’ll even cover some…around 12%.  That leaves me paying appx. $83.  I can, but how many can’t?  How many will have to endure additional suffering for this and other procedures because their insurance companies won’t cover state of the art treatments or prescriptions?

I wonder how many of us feel like victims at times, little Davids or Davidas nearly helpless in the face of Goliath’s rules handed down from on high that often don’t serve those who are paying for service.  If we spend our time and make the effort to take on the insurance company, to question or appeal any decision or charge we don’t agree with or understand, is victory worth it on principle, or do we have a chance of actually saving money?  Or do we just pay the bill?  Should we be grateful to have any coverage at all?

The Little Toe that Could

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Faithful readers know that the toe in question is actually my big toe, which I first wrote about two weeks ago. Thanks in part to the amazing power of the Internet, my blog about my toe has already fomented change…on a personal and national level.

I’d written that Aetna wouldn’t cover the toe joint replacement surgery I need because they considered it experimental, though the procedure is FDA approved. Another blog picked up the discussion.

Later that day, I got a call from Aetna’s executive response team! My contact was very helpful, and sounded truly concerned about my case. And, he actually followed up on everything he said he would. Then the people he spoke with followed up in a timely fashion. (Having had a couple of frustrating experiences with customer service at large corporations recently, I am a bit skeptical about the quality and speed of response.)

One week later, my doctor had sent my information and discussed the procedure with a doctor there. The week after that, Aetna decided to cover my surgery…and to cover it in the future! They’ve already updated Clinical Policy Bulletin 0708 to reflect this change.

My feet and I thank Aetna, my doctor, and everyone involved for being open to taking action, and doing so quickly. But of course every insurance company won’t and can’t decide to cover every procedure because someone blogs about it.

P.S. How many people could be impacted by this policy update? I’ll keep looking, but haven’t yet found a statistic saying how many adults suffer from hallux rigidus, or degenerative arthritis of the big toe…