For the Sake of Humanity, Nuke Aetna

If I were typing this two weeks ago, I would have meant that by nuking Aetna, we should nuke all HMOs.  Due to my recent experiences with Aetna, I have decided they should at very least be first.  Perhaps if we nuke Aetna, the rest of the thieving bastards will fall in line (but don’t hold your breath).

It started, like these things tend to do, with a simple question:

Can I see the chiropractor that I’ve been seeing all my life?

The answer is that it’s not that simple, as these answers tend to be.

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I have hated HMOs since long before I was forced to sign up for one.  My company offered me a choice of two insurances: Aetna HMO or a different HMO.  It’s like voting republican or democrat: you’re gonna get screwed either way.

My road has been fairly smooth thus far, for which I should no doubt feel thankful, but somehow I don’t.  It might be the outrageous premiums, which go up between five and fifteen percent every year.  It might be the ever-decreasing services that I may receive or the ever-increasing copays I must pay.

But as I said, all I wanted to know was if my chiropractor was covered.  Aetna has been one of the last to allow chiropractors into the network.  In fact, they paid for acupuncture long before chiropractors.  Discovering that some chiropractors were covered, I went right where I’m always told to go when I ask an insurance question: to the insurer’s website.  I understand that the listing of physicians is completely out of date by the time it’s printed, so that’s not an issue.

Going to the Aetna site was my first mistake.

[A cynic would state that requiring healthcare was my first mistake but why quibble?]

I was greeted warmly by the site, then sat staring at it for a while.  It became obvious that this wasn’t going to be an easy task.  Options, options everywhere.  I figured why not register first, even though I don’t like registering for anything.  I was validated in my feelings about registration when the site informed me it could not register me and why didn’t I come back later.

Ok, I figured I’d try by insurance type.  There is a list of types, approximately one page long.  Nothing looked close so I pulled out my card, which said two things: Aetna and HMO.  You know by this point that there were multiple HMOs listed and no way to figure out which one was mine.

There is more than one way to skin a politician, so I figured why not try simply looking for a doctor.  This was a bit more navigable, fortunately.  Lo and bloody well behold, I found my chiropractor!  I haven’t seen the old boy in a year or two and was surprised to find out he accepted Aetna HMO’s.

Down at the bottom of the screen was a box that said something to the effect of National Participating Practitioner.  This particular cynic read that as not necessarily meaning my insurance will cover me.  This turned out to be a wise move.   ( <—- foreshadowing technique)

Since I was largely getting nowhere, I took this over to the head of the Benefits department, who knows something about benefits.  She looked at the listing and said, “This tells me nothing.”  I allowed as to how I was glad we were in total agreement.   The entire website could be described as user-hostile.

The head of Benefits called Aetna, which, as one would expect, was not answering the phone.  She emailed.

Three days later I received a response.  No, the chiropractor was not covered.

Good thing I wasn’t in the midst of a cardiac event, no?

I asked if a different doctor was in the network, now that I had her attention.  I also asked if there was anybody at Aetna interested in improving the user experience of their website - I’d love to assist somehow.  Finally I asked the procedure for seeing a specialist.

A few days later the response arrived.  No, the other doctor wasn’t in-network either.  As for seeing a specialist, had I asked member services?  I thought she was member services, so no, I hadn’t asked member services.  As for improving the website, there was no answer, which I suspect was the answer.

She went on to tell me how easy the site was to use: after all, she uses it all the time!

Of course she uses it all the time - it’s her job.

Meanwhile a reasonably intelligent guy (who used to do medical billing) and the head of Benefits can’t get an answer from this `easy to use’ website.  My wife tried earlier and totally gave up.

So I have an insurance with a customer service portal that can’t be operated by most people who don’t work for Aetna (and probably most who do work for Aetna).  I have the email address of somebody, who isn’t member services, and I have an answer on two of my doctors (NO).  I have no idea how the answer was arrived at and no idea how to figure out whether other doctors are in-network.

BY JOBE, I’VE GOT IT!

The reason no one is interested in making the website functional is that people whould then be able to locate a doctor and, heaven forbid, see the doctor.  Because if they see the doctor, Aetna might have to pay the doctor.  Just kidding - HMOs don’t have to pay, even with a referral, precert and a copay.

Next time my premiums are due, I’m going to tell them they have to bill me.  If they can’t find my address, they can use my handy website to look it up.  If they ever manage to find my name, no matter how badly misspelled and mangled, I will be listed as National Non-Participating Patient, meaning that they can’t bill me without prior authorization, referrals, and a non-refundable $150 copay per-bill.