Cost of Being Underinsured: His Right Arm

[arnguy]

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.

 

[djs]

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.

Dan

 

[arnguy]

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.

 

[J.R.]

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.

 

[somarco]

Let me see if I got this straight.

Aetna used a repo man to take back his arm?

 

[STIBROKER]

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........

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.

 

[J.R.]

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.

 

[TXINSURANCE]

If he would have bought a Right Start plan this could have all been avoided.

(joke)

 

[Crabcake Johnny]

In MD Aetna's benefit for DME is $2,000.

 

[TXINSURANCE]

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.