It's likely you have had a negative experience with an insurance company. I know I have. Cough, Healthnet, Cough. (It's just how you want to spend your time grieving; justifying the emergency room visit that your mother made three weeks before her death--the one where they took the first steps toward diagnosing her terminal lung cancer--AFTER she died from the thing they didn't consider an emergency).
Today, though I want to tell you about the phenomenal experience I've had with an insurance company: Aetna. We were insured with an Aetna HMO plan through my husband's employer (though we paid the lion's share of the premium) when Social Butterfly became ill with anorexia. When her pediatrician referred her to an out-of-network, but world-renowned and evidence-based, treatment program--The UCSD Eating Disorder Treatment Program, I (having vast personal and professional experience with health insurance) asked, "What if they won't let us go out-of-network?" The doctor replied with conviction, "I will make them. They don't have anything appropriate for her in-network."
When I talked to the insurance person at UCSD she informed me that a contract was in the works for them to become in-network at UCSD and that she was sure Aetna would approve a single-case in-network contract for my daughter's treatment. "How much?" I asked. "Your deductible is $2,500 and then they cover everything; will that be okay?"
"Okay?! Hold the phone while I turn some cartwheels."
Two weeks after Social Butterfly started treatment, I was made full-time at my job; since I work for a very large corporation, the benefits are both spectacular and inexpensive. Their plan is an Aetna PPO. We kept two weeks of plan overlap with my husband's while I made sure that what the 17 different people I called at Aetna told me was true. Our deductible would reset, but treatment would not be interrupted. One savvy soul who knew my neurotic worry would only be resolved by having something in writing, gave me the link to the company policy on eating disorders--unless your employer excludes ED coverage, you get this. They were true to their word.
From day one of my daughter's entrance into the program, her treatment was guided by what the professionals at UCSD thought was appropriate for her. Many insuance companies authorize ED treatment three days at a time. Aetna gave us 10 days at a time and renewed without missing a beat. My daughter went off full-days to half-days and, when the staff decided it was too soon, she went back on full-days. Her case mananger worked with the program every single step of the way and never second-guessed them.
I have expressed my gratitude to her personally.
Not only that, but Aetna assigned a case manager to me (since she's a minor). She called me every two weeks to see how things were going, did we need more services, referrals, anything at all--she was there to help us navigate the system. Last week we had our last conversation where I thanked her for always being ready to help, but was confident we have a good plan in place for college.
I don't know the exact number that Aetna's spent on my daughter so far, but I do know it is in excess of $100,000. And it was money well-spent--both in a business sense (how much would one hospitalization cost?) and and an ethical/moral sense. We have spent about $5,000 out-of-pocket because of our dual deductibles--which was worth paying because our monthly premiums were halved by switching plans.
What did all of this mean to me, not in dollars and cents, but in peace of mind? It was, as the Mastercard commercial says, priceless.
I was able to devote all my energy--and believe me, this took every ounce of energy that I possess as a fairly high-energy, organized, go-getter type to fight and (fingers crossed and hopeful) helpy my daughter vanquish the monster that is anorexia.
Thank you, Aetna. You have my eternal gratitude.*
*P.S. Not to turn this all political, but this is just what I want for the rest of America-rich or poor. I am omitting horror stories about other insurance companies from this post because I want to celebrate Aetna, but boy do I know some.