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Re: [IP] Pump/Insurance - Aetna

Jan wrote:

 >>I received the following: > Jan, since you are on that big pumper list, 
can you > ask to see if anyone there has any experience with Aetna US 
Health Care (HMO)? Can anyone help? Thanks. 0\0 <<

I was on an Aetna US HealthCare HMO plan for several years and I have to 
say that, on my plan at least, the coverage was superb.  Pump supplies at 
100%, generic prescription copay $5.00, doctor visit copay $10.00, option 
for free 3-month mail order generic prescriptions.  The main problem I had 
was that they continually denied coverage of things they were required by 
law and/or contract to cover.  So I was forever on the phone with them 
trying to get things cleared up.  They would pay eventually but I had to 
waste a lot of time making waves before it happened.  Every time I got a 
letter from them my stomach would tie up in a knot because I knew it meant 
another battle.  My only consolation was knowing that being in arrears 
paying medical bills does not affect your credit rating.

I did get them to ease up for about 9 months by suggesting to a manager 
that they were trying to float their debt by forestalling claim 
payments.  I think that really hit a nerve.

Also, I think I was signed up with them for 5 months before I finally got a 
straight answer about where I had to order my pump supplies from to have 
them covered.  Trying to get this information was like trying to pull a 
boulder out of a black hole.  This could have been because they had just 
acquired another company and therefore the new people didn't know the ins 
and outs yet, but that's really no excuse.  If I hadn't had enough supplies 
stored up I would have been left high and dry for almost half a year.  This 
was in 1997 or so, so insulin pumping was not a new technology.  And I was 
paying my insurance premium the whole time.

That being said, they eventually covered a lot more than any other plan 
I've been on.  They were just very high maintenance.
I thought they were horrible while I was with them but in retrospect I'd 
like to go back.

Your friend can feel free to email me with any questions.

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