#aetna medical insurance for

[starry-genome]

If you have ever wondered why health insurance in the US is so messed up, I highly recommend checking out Dr. Glaucomflecken’s 30 days of Healthcare series. Click here for the YouTube playlist or click here for the TikTok playlist.

Each video is about 1-3 minutes and goes through different aspects of the healthcare industry explaining how it works and especially how corrupt it is.

I spent 5 years working hospital finance watching the way health insurance directly affected my patients, and oftentimes seeing the ways lack of access to affordable healthcare resulted in chronic and emergent conditions, and even death. I cannot stress enough that I literally saw people die because their insurance denied them treatment. And on the billing side, the things people would complain about to me as something the doctors or hospital were doing wrong were usually a direct result of the way health insurance runs everything. It’s disgusting.

At the end of the series, he has a call to action - ways we (as regular people) can help work to improve healthcare (other than pushing for universal healthcare/Medicare for all). A lot of people talk about how ridiculous US Healthcare is but rarely do I see anyone talking about what we can do to change it. I think this is the most important video of all, so I’m including it here.

This video series is probably the most comprehensive, easiest to understand breakdown of the way healthcare fucks everyone over - patients, doctors, and hospitals alike. Please check it out!

[tj-crochets]

Hey y'all! I am once again in health insurance hell, and could really use some help. I have a specific US health insurance question, but it might get long so it's below a read more

My employer offers two health plan options, and they are both absolutely terrible. I want to get my own health insurance, but the insurance broker lady I used when I worked part time says I can't, because I can get health insurance through my employer, even if I opt out. I spoke to another health insurance person today, and she said if I get a letter on company letterhead saying I'll lose health insurance on [date], as long as it's 60 days or less from now, it counts as a qualifying event and I can buy my own health insurance. She said opting out counted as losing health insurance. Do you know anything about this? How do I get health insurance as an individual NOT through my employer even though my employer offers it? The plans my employer is offering are Aetna, and Aetna is the absolute worst and I despise them as a company so much one of my long term goals is to warn people against them. They suck! They refused to pay for my inhaler until I got my doctor to fill out a form like three times, and also I had to email them A LOT and fill out a LOT of surveys with an emphasis on how horrifying I found it that they as a company clearly valued profit over their customer's lives, and would in fact prefer their customers die before they could reach the ER in case of an emergency, as evidenced by their refusing to pay for my rescue inhaler, a necessary life-saving medication. They also require I fill that form out every year, just in case I magically stop being in the small minority of people who get severe adverse reactions to albuterol and levalbuterol

[allthegeopolitics]

A major US health insurance company is making artificial insemination available on all its eligible plans – regardless of sexual orientation or partner status. Aetna, a subsidiary of CVS Health, announced the landmark change its intrauterine insemination (IUI) policy on Tuesday (27 August). Members can access the benefit as a test of fertility and, in some cases, to increase the chances of pregnancy.

Continue Reading

[justinspoliticalcorner]

Andrew Perez at Rolling Stone:

EARLIER THIS WEEK, two Democratic senators announced they have requested a criminal investigation into Supreme Court Justice Clarence Thomas — regarding, in part, a loan for a luxury RV provided by a longtime executive at UnitedHealth Group, one of America’s largest health insurers. Thomas apparently recused himself in at least two cases involving UnitedHealth when the loan was active, according to a Rolling Stone review. Yet, he separately chose to participate in another health insurance case and authored the court’s unanimous opinion in 2004. The ruling broadly benefited the industry — shielding employer-sponsored health insurers from damages if they refuse to cover certain services and patients are harmed. Thomas’ advice to patients facing such denials? Pull out your checkbook.

While UnitedHealth was not a party to the case, the company belonged to two trade associations that filed a brief urging the Supreme Court to side with the insurers.  “As we saw so starkly this term, Supreme Court decisions can have sweeping collateral implications: If the court rules in favor of one insurance giant, for instance, it tends to be a boon for all the other insurance giants, too,” says Alex Aronson, executive director at the judicial reform group Court Accountability. “That was the case here, and it’s a perfect example of why justices shouldn’t accept gifts — especially secret ones — from industry titans whose interests are implicated, whether directly or indirectly, by their rulings.” The public had no way of knowing about Thomas’ RV loan at the time of the decision: The loan was only exposed by The New York Times last year. Senate Democrats investigating Thomas believe that much or all of the loan, for a $267,230 motor coach, was ultimately forgiven. Sens. Sheldon Whitehouse (D-R.I.) and Ron Wyden (D-Ore.) recently requested the Justice Department investigate whether Thomas reported the forgiven portion of the loan on his tax filings, after he failed to disclose it in ethics forms.

Meanwhile, Thomas’ health insurance opinion has had wide-ranging, long-lasting ramifications, according to Mark DeBofsky, an employee benefits lawyer and former law professor.  “It hasn’t been rectified. The repercussions continue,” DeBofsky tells Rolling Stone. “People who are in dire need of specific medical care, and [their] insurance company turns around and says, ‘That care is not medically necessary,’ and there’s an adverse outcome as a result of the denial of the treatment, or hospitalization, or service — there’s no recompense for what could have been an unnecessary death or serious injury.” Since last year, the Supreme Court has faced an unprecedented ethics crisis, with much of the focus aimed squarely at Thomas. ProPublica reported that Thomas received and failed to disclose two decades worth of luxury gifts from a conservative billionaire, Harlan Crow, who allegedly provided free private jet and superyacht trips to Thomas and his wife; bought a house from Thomas and allowed the justice’s elderly mother to live there for free; and paid for at least two years of boarding school tuition for Thomas’ grandnephew.

[...] Federal law requires Supreme Court justices to recuse themselves in any case where their “impartiality might reasonably be questioned.” The justices decide for themselves when such a move is necessary — and when they do withdraw from a case, they rarely say why. Thomas does not appear to have explained his decision to withdraw from the two matters that directly involved UnitedHealth. Thomas did not take similar steps in Aetna Health Inc. v. Davila, a case that broadly affected the health insurance industry. He instead authored the court’s opinion, which expanded insurers’ favorite tool for limiting liability: ERISA. Congress passed the Employee Retirement Income Security Act, commonly known as ERISA, in 1974 to protect employee benefits. The law is relatively vague when it comes to “welfare benefits,” and contains a broad preemption clause. The courts have filled in the blanks — including in the Aetna Health case — with distressing results for patients. Half of Americans have employer-sponsored health insurance coverage; nearly all of these plans are governed by ERISA.

Rolling Stone exposes how SCOTUS Justice Clarence Thomas received a $267K RV from a health insurance executive.

[partisan-by-default]

Aetna, a subsidiary of CVS Health, announced the landmark change its intrauterine insemination (IUI) policy on Tuesday (27 August). Members can access the benefit as a test of fertility and, in some cases, to increase the chances of pregnancy.

“Expanding IUI coverage is yet another demonstration of Aetna’s commitment to women’s health across all communities, including LGBTQ+ and unpartnered people,” the company’s chief medical officer, Cathy Moffitt, said.

“This industry-leading policy change is a stake in the ground, reflecting Aetna’s support of all who need to use this benefit as a preliminary step in building their family.”

Aetna is one of the United States’ largest medical insurance providers, serving over 35 million people and when combined with the rest of CVS Health, makes up 11 per cent of the market share.

[truthwithlight]

oh my god i can't take this shit anymore 😭 now my insurance is saying they won't approve my medication until they get "proof it's clinically necessary"??? my doctor already sent you the relevant records what more do you fucking need?

i've missed 3 doses now that's a month and a half without any sort of treatment. my knees and hips hurt so badly that i can't walk for more than like 10 minutes without getting exhausted and upset and needing to sit down. i went to the aquarium the other day and only saw less than half of it before leaving because walking for that long was beyond exhausting. i'm essentially confined to my house and painful trips to the store at this point. i'm fucking miserable

getting to the point where even sitting and lying down all day is uncomfortable because my hips are constantly stiff and sore. back to the "mom is concerned because i nap more than half the day and she doesn't even know how bad my mental health is" stage i was at before initially going on my medication

fuck insurance fuck aetna fuck my stupid baka life

[kineticpenguin]

You wanna know what's really fucked up? The last few orders that have sent me into orbit on pure ragethrust are ones where the patient's deductible and out of pocket were fully met. And yet I have to hunt down the exact right provider avenue to make sure the procedure is paid for. Despite being a layman I have to explain precise medical terms to other drones on the phone.

Even when you've been hurting all year so you've paid so much for medical care your insurance company agrees -on paper- to pay for everything, they make it so, so, SO fucking hard to actually bill them for services they agreed to pay for in full.

Every day, just trying to get patients care that they should automatically receive because they have already spent thousands of dollars, I encounter new gatekeepers. There are the main ones, of course: Availity, United Health. Except for all the subcategories and subcontractors. UMR. Sierra. Silver Summit. A Blue Cross Blue Shield for every state, and even then, there's Anthem, Premera, Regence, Independence. Telligen. Qualitrac. Navinet. Evicore. Molina. Medicaid managed care through any of the above. Aetna. Cigna.

[religion-is-a-mental-illness]

By: Christina Buttons

Published: Feb 21, 2024

The Arizona Mirror published an article earlier this month titled "The latest GOP anti-trans strategy: Requiring ‘detransition’ services," arguing that legislation aimed at providing healthcare and insurance coverage for detransitioners is unnecessary—it is merely a tactic by Republicans to hassle people who currently identify as transgender. The article was republished under the same title in the Phoenix New Times.

The article focuses on an Arizona senate bill that would make the pathway of detransition easier for those who are struggling to get the healthcare they need. Currently, there are no billing codes for detransitioning, nor is there anything resembling a standard of care for this growing population. Additionally, some insurance companies explicitly exclude gender-reversal procedures.

But you wouldn’t learn any of this from reading the Arizona Mirror. It appears that the author, Gloria Gomez, only writes about the bill in an attempt to discredit it. The articles’ premise is that detransitioners face no difficulties in accessing healthcare and this bill is merely a scheme designed to inconvenience people who currently identify as transgender.

Gomez does not speak to a single detransitioner, opting instead to quote gender activists who argue the bill is “unnecessary” and not a “real issue” because detransitioners’ “medical needs are already covered by insurance.”

The first half of this article will debunk these misleading claims and clarify the purpose and necessity of detransition healthcare bills, offering a new contribution to the discourse. The latter half will counter several common misleading claims about detransition and "gender-affirming care" made by Gomez. For those familiar with my work, I often address these claims, so some of the content may be drawn from earlier writings.

Gomez quotes two representatives from the Human Rights Campaign (HRC), the largest LGBTQ political lobbying organization in the United States, which received $50 million in donations in 2023. The HRC regularly protests the New York Times' coverage of detransitioners and the inadequacies of the "gender affirming" model of care.

-

Misleading Claim #1: Detransitioners’ medical needs are “already covered by health insurance”

An emailed statement by Cathryn Oakley, the senior director of legal policy for the Human Rights Campaign (HRC) said:

“This bill is an unnecessary and gratuitous excuse to talk about detransition in an effort to shift the focus from the actual health care that transgender people receive, which is supported by every mainstream American medical health organization, to the care of a very small number of folks whose medical needs are already covered by health insurance.”

For many detransitioners, this is false.

There is significant variability among insurance policies regarding what is covered, leading to disparities in access to care. While some insurers may cover detransition care under certain conditions, others may not, deeming the care not medically necessary.

Had Gomez done any research she’d know some insurance companies explicitly exclude detransition healthcare—like Capital Blue, which has a stipulation in its plans stating gender-reversal surgery is “considered not medically necessary and, therefore, not covered.” 

[ Capital Blue ]

…or United Healthcare Community Plan, which excludes “reversal of genital surgery or reversal of surgery to revise secondary sex characteristics.”

[ United Health Community Plan ]

Others evaluate on a case-by-case basis (California Health & Wellness) or if certain criteria are met (Wellmark), and thankfully, some health insurance companies do cover detransition healthcare (Aetna). These are just a few examples and by no means an exhaustive list. I plan to conduct a much larger overview of insurance providers’ coverage of detransition care in a future investigative article.

-

Misleading Claim #2: Detransitioners receive the same care as those seeking to transition

Bridget Sharpe, the director of HRC's Arizona branch, who responded to the Arizona Mirror's request for comment, said:

“The care for people who detransition is the same as the care for transgender people. Any medical service that affirms someone’s gender includes someone who decides to detransition. If they decide to detransition they are affirming their gender.” 

This is not accurate.

Under the current system, when someone transitions, they receive a diagnosis code indicating gender dysphoria. When someone detransitions, they no longer meet the criteria for a gender dysphoria diagnosis. Without a specific diagnosis like gender dysphoria to justify “medical necessity,” obtaining coverage for detransition procedures can be complicated, demonstrating the need for legislation that ensures detransition is covered.

Legislation like SB 1511, which mandates that doctors, health care institutions, or any other licensed health care providers in Arizona offering gender transition procedures must also provide gender detransition procedures. Furthermore, if an insurance policy covers gender transition, it will be required to "provide or pay" for detransition procedures.

A third provision aims to collect information on how many people are requesting detransition procedures by requiring insurance companies to submit a report. Currently, there is no method for tracking detransition, so we don't know how many people are detransitioning.

Gathering more data on detransitioners would aid in the process of acquiring new billing codes from coding authorities. Nine months ago, FAIR in Medicine submitted an application to the Centers for Disease Control and Prevention (CDC) for International Classification of Disease (ICD) diagnosis codes specific to detransition. This application is currently under review. The process to review and approve new ICD diagnosis codes can take over a year and involves several steps, including gathering data, public comment, and revision.

The absence of dedicated medical billing codes for detransition procedures creates a significant barrier for healthcare providers seeking reimbursement for these services. Consequently, they may resort to using inaccurate billing codes.

In practice, healthcare professionals apply their discretion to navigate these challenges. For example, a detransitioned woman who underwent a hysterectomy as part of her transgender experience might be classified similarly to a postmenopausal woman for the purposes of accessing hormone replacement therapy.

An important article by Drs. Aida Cerundolo and Carrie Mendoza on detransition billing codes highlights a case like this: A woman named Katie began taking testosterone at 19, underwent a double mastectomy at 20, and had a hysterectomy at 24. Shortly after, she realized transitioning was a mistake.

Now at 25, Katie is experiencing early menopause and has had significant difficulty obtaining the correct hormone dosage. Even after numerous phone calls, she was prescribed estrogen at a dose typically given to males seeking to become transgender women, which was not suitable for her needs. For obvious reasons, this is not a sustainable solution. We need detransition billing codes.

-

Misleading Claim #3: Detransition healthcare is not a “real issue”

The director of HRC's Arizona branch, Bridget Sharpe, continued her statement by saying:

Instead of resolving a real issue, Sharpe said, the Republican legislation instead seeks to weaponize detransitioning against transgender health care.

It is insulting to dismiss detransitioners’ healthcare needs as not a “real issue.”

Had Gomez interviewed any detransitioners or reviewed research on them, she would understand that many encounter challenges in finding information on detransition or healthcare professionals equipped to address their specific needs.

A 2021 international survey of 237 detransitioners found the support available to detransitioners to meet their medical needs is currently inadequate.

49% seek accurate information on stopping or changing hormonal treatment.

24% require assistance for complications from surgeries or hormonal treatments.

15% need information on and access to reversal surgeries or procedures.

7% provided other responses not listed, such as the need for tests to assess current reproductive health, information on the long-term effects of cross-sex hormones, the health consequences of undergoing a full hysterectomy, and issues related to pain from chest binding.

My preliminary survey of 94 detransitioners and desisters (pending publication) revealed that 72% of those seeking medical assistance faced significant challenges, and 78% of those who sought insurance coverage for detransition services had difficulty accessing it.

I've interviewed several detransitioners who have had immense difficulty in getting insurance coverage for detransition-related needs. One male detransitioner had to wait a full year to have his breast implants removed. Others have turned to crowdfunding to finance their detransition-related procedures.

However, one detransitioner I recently spoke with had no issues in getting insurance coverage for breast reconstruction surgery, which I believe is due to a growing awareness of detransitioners' needs in the last year.

-

Activist-journalism

In the last decade, influential activist organizations, including HRC, GLAAD, ACLU, and SPLC, have collaborated closely to shape the narrative on transgender issues. They provide news outlets with a range of media reference guides, stylebooks, fact sheets, and other resources, equipping mainstream journalists—most of whom are not well-informed on the debate surrounding youth medical transition—with the materials needed to present a biased perspective and label any valid concerns as bigotry. This approach effectively transforms journalists into activists.

Activists rely on propaganda tactics like the illusory truth effect—the tendency for people to believe things that are false after repeated exposure. This strategy of creating a semblance of public agreement benefits from the support of progressive platforms like the Arizona Mirror, which claims to be “an independent, nonprofit news organization” yet serves as an example of political activism masquerading as journalism. Their reporting standards neglect objectivity and thorough research, delivering a skewed narrative that deceives the public.

It seems ironic that progressives who champion “healthcare for all” would try to undermine bills aimed at ensuring a vulnerable group has access to healthcare. And like Pamela Paul pointed out in her recent New York Times op-ed, “These are people who were once the trans-identified kids that so many organizations say they’re trying to protect.”

Activist organizations frequently ignore or downplay the experiences of individuals who have detransitioned, despite these being the same individuals they pledge to support. This neglect is a significant departure from their stated principles. For many, a transgender identity is not a lifelong experience — they need support too.

-

Additional reading:

Misleading Claim #4: Detransition is rare

Gomez states that people who detransition "represent an extreme minority of the transgender experience." To support this statement, she cites the U.S. Transgender Survey of 2015, which is a deeply flawed sample consisting primarily of older adults who transitioned under a medical model vastly different from the current gender-affirmation model concerning youth and young adults.

The study included only those who identified as transgender at the time they took the survey, which, by definition, excludes detransitioners. Gomez overlooks more recent, robust, and representative studies that challenge the notion that detransition is rare, such as a 2022 comprehensive review of medical records that found 30% of teens and young adults discontinued cross-sex hormones after 4 years.

A 2021 study found that 75% of detransitioners did not inform their doctors about their decision to detransition. The rate of detransition remains unknown and is difficult to track, partly due to the absence of specific medical billing codes for detransition procedures.

-

Misleading Claim #5: Youth medical transition is backed by major medical organizations

Gomez relies on an appeal to authority fallacy by stating that puberty blockers and cross-sex hormones for minors are “backed by major medical associations as safe and necessary for the well-being of transgender people.” But these US-based medical organizations are not basing their recommendations on the best available evidence.

Systematic evidence reviews—widely recognized as the gold standard in evidence-based medicine (EBM)—have found that the risks of youth medical transition outweigh any purported benefits.

Public health agencies in Finland, Sweden, England, Denmark and soon Norway have aligned their guidelines with systematic evidence reviews, and have adopted a far more restrictive and cautious approach, one that prioritizes psychotherapy.  

Medical authorities in several other countries including France, Ireland, Italy, the Netherlands, Australia, and New Zealand, have begun expressing concerns or are in the process of reevaluating their stance on transitioning minors. 

US-based medical organizations in favor of youth medical transition have not aligned their guidelines with systematic evidence reviews, actively resisting such calls for many years. However, just last year, the American Academy of Pediatrics (AAP) finally announced it will be conducting its own systematic evidence review.

The unfortunate reality is that a small, ideologically-motivated group of individuals in charge of US-based medical organizations are acting as political entities that represent specific interest groups and invest heavily in lobbying.

Last year, international experts publicly weighed in on the American debate over "gender-affirming care" for the first time. 21 leading experts on pediatric gender medicine from eight countries wrote a letter expressing disagreement with US-based medical organizations over the treatment of gender dysphoria in youth, urging them to align their recommendations with unbiased evidence “rather than exaggerating the benefits and minimizing the risks.”

Dr. Gordon Guyatt, a clinical epidemiologist at McMaster University and founder of the evidence-based medicine (EBM) movement, who is a highly respected figure in the field of medical research methods and evidence evaluation, has stated that the current guidelines in the US for managing gender dysphoria in adolescents are "untrustworthy" and should not be considered evidence-based.

Guyatt adds that the guidelines fail to offer cautious and conditional recommendations appropriate for the low-quality evidence, highlighting that European policies are ”much more aligned with the evidence than are the Americans.”

-

Misleading Claim #6: Bills aimed at safeguarding youth and vulnerable adults are “anti trans”

Gomez refers to detransitioner Chloe Cole, who transitioned as a minor and spoke in favor of SB 1511, as “a frequent supporter of anti trans legislation.”

Activists and activist-journalists rely heavily on the label “anti-trans,” a strategy referred to as poisoning the well. By branding anyone or anything critical of youth medical transition as motivated by bigotry, they skew the audience’s perception, making them less receptive to other viewpoints.

Legislation aimed at protecting youth (and sometimes vulnerable young adults with psychiatric comorbidities) from a reckless model of care is not “anti-trans,” it is pro-safeguarding. Gender activists have spent years lobbying to remove these protective measures, which they call “gatekeeping.”

Many states that have placed restrictions on medical transition services have not included provisions for detransition or gender-reversal procedures, which is why some are doing so now. Earlier this month, the Tennessee House filed a bill requiring gender clinics to perform detransition procedures.

Do No Harm, an organization dedicated to scientific integrity and ethics in medicine, introduced model legislation last year called the Detransitioner Bill of Rights, which has already been used in several states.

-

Misleading Claim #7: Republicans are the sole proponents of age restrictions on medical transition services

Throughout the article, Gomez repeatedly identifies Republican lawmakers as proponents of "anti-trans legislation," stating, "far-right politicians have latched onto detransitioners to justify their calls to curtail gender-affirming care."

This perspective overlooks the broader context and the international consensus among European countries, arguably more progressive than the United States, that have drastically scaled back on youth medical transition. It also ignores the bipartisan support that opposition to youth transition policies is now receiving in the United States, as groups of Democrats in four states (Louisiana, Maine, New Hampshire, and Texas) have voted against them.

There's also a new organization called Democrats for an Informed Approach to Gender (DIAG), which seeks to organize initiatives for left-leaning individuals that oppose youth transition. Additionally, organizations like Genspect, the Society for Evidence-Based Gender Medicine (SEGM), the LGBT Courage Coalition, the Gender Dysphoria Alliance, and others are non-partisan but primarily consist of healthcare professionals and researchers who identify as liberal or left-leaning, or at least did at some point in time.

Age restrictions on youth medical transition reflect broader public opinion across the political spectrum. A 2023 Washington Post-KFF poll found a majority of adults (nearly 7 out of 10) oppose allowing children aged 10 to 14 access to puberty-blocking drugs, and a similar majority (6 out of 10) opposes cross-sex hormones for 15- to 17-year-olds.

It's regrettable that legislative intervention has become necessary, but as medical organizations continue to let ideologues dictate policies and silence more moderate voices within the profession, lawmakers are left with little choice but to step in.

==

If you haven't already spotted the moral-religious overtones in this ideology, I don't know what more to show you.

The people who insist that "Gender Affirming Treatment" is "healthcare" and "not about you, it's about us and our survival," also want you to believe that care for detransitioners is all about them and attacking them. The narcissism and sociopathy are completely off the charts.

What they're actually afraid of is the scale of this medical scandal. At present, there's no insurance coverage, no billing codes, and limited doctor accountability, which will change as lawsuits proceed. Activists can claim that detransition is "rare" because the medical system doesn't track it. Detransitioners frequently do not return to the same doctor-activist who drugged or carved them up in the first place and are forced to simply "make do." Legal coverage of detransition isn't just a recognition of the phenomenon of detransition and the flaws of simply "affirming" everyone but will also reveal in fine grain detail the extent of it, in a way activists will be unable to continue lie about.

Meanwhile...

[darkmaga-retard]

Wendell Potter

Aug 08, 2024

Over the past few days, both CVS/Aetna and Humana admitted to Wall Street that their Medicare Advantage plans are not nearly as profitable as those insurers had predicted a year ago. As a consequence, hundreds of thousands – and probably millions – of seniors and disabled people enrolled in Aetna’s and Humana’s plans may soon wish they had never heard of Medicare Advantage.

Aetna president Brian Kane probably wishes he had never heard of Medicare Advantage, either. The poor guy got canned in a very public way yesterday, presumably for overseeing the payment of too many Medicare Advantage claims during his short tenure at Aetna. His boss, CVS CEO Karen Lynch, said during the company’s second-quarter earnings call with investors and Wall Street financial analysts that Kane, who joined the company just last September, was leaving Aetna “immediately.”

As sorry as I am for Kane, I am much more concerned about the health and well-being of the 4.3 million people enrolled in CVS’s MA plans and the 6.2 million in Humana’s plans. Sadly, most will find they’re trapped in a circle of hell created by the insurance industry, unable to stay in their current Medicare Advantage plan but also unable to return to traditional Medicare because of what for them will be unaffordable Medicare supplemental policies (most of which are sold by the same big insurers that sell MA plans). Seniors have six months from the date they’re eligible for Medicare to buy a supplemental (Medigap) policy to cover out-of-pocket expenses. If they’ve been enrolled in an MA plan longer than six months, they’ll have to go through medical underwriting. That means that if they’re being treated for much of anything or, God forbid, have a “preexisting condition,” they’ll have to pay an arm and a leg for Medigap policy.

[dertaglichedan]

15 health systems dropping Medicare Advantage plans | 2024

Medicare Advantage provides health coverage to more than half of the nation's older adults, but some hospitals and health systems are opting to end their contracts with MA plans over administrative challenges.

Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers.

In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.

In January, the Healthcare Financial Management Association released a survey of 135 health system CFOs, which found that 16% of systems are planning to stop accepting one or more MA plans in the next two years. Another 45% said they are considering the same but have not made a final decision. The report also found that 62% of CFOs believe collecting from MA is "significantly more difficult" than it was two years ago.

Fifteen health systems dropping Medicare Advantage plans in 2024: Editor's note: This is not an exhaustive list. It will continue to be updated this year 1. Canton, Ohio-based Aultman Health System's hospitals will no longer be in network with Humana Medicare Advantage after July 1, and its physicians will no longer be in network after Aug. 1.

2. Albany (N.Y.) Med Health System stopped accepting Humana Medicare Advantage on July 1.

3. Munster, Ind.-based Powers Health (formerly Community Healthcare System) went out of network with Humana and Aetna's Medicare Advantage plans on June 1.

4. Lawton, Okla.-based Comanche County Memorial Hospital stopped accepting UnitedHealthcare Medicare Advantage plans on May 1.

5. Houston-based Memorial Hermann Health System stopped contracting with Humana Medicare Advantage on Jan. 1.

6. York, Pa.-based WellSpan Health stopped accepting Humana Medicare Advantage and UnitedHealthcare Medicare Advantage plans on Jan. 1. UnitedHealthcare D-SNP plans in some locations are still accepted.

7. Newark, Del.-based ChristianaCare is out of network with Humana's Medicare Advantage plans as of Jan. 1, with the exception of home health services.

8. Greenville, N.C.-based ECU Health stopped accepting Humana's Medicare Advantage plans in January.

9. Zanesville, Ohio-based Genesis Healthcare System dropped Anthem BCBS and Humana Medicare Advantage plans in January.

10. Corvallis, Ore.-based Samaritan Health Services' hospitals went out of network with UnitedHealthcare's Medicare Advantage plans on Jan. 9. Samaritan's physicians and provider services will be out of network on Nov. 1.

11. Cameron (Mo.) Regional Medical Center stopped accepting Aetna and Humana Medicare Advantage in 2024.

12. Bend, Ore.-based St. Charles Health System stopped accepting Humana Medicare Advantage on Jan. 1 and Centene MA on Feb. 1. 

13. Brookings (S.D.) Health System stopped accepting all Medicare Advantage plans in 2024.

14. Louisville, Ky.-based Baptist Health went out of network with UnitedHealthcare Medicare Advantage and Centene's WellCare on Jan. 1. 15. San Diego-based Scripps Health ended all Medicare Advantage contracts for its integrated medical groups, effective Jan. 1.

[tj-crochets]

Hey y’all! Aetna (the worst health insurance company I’ve dealt with) denied my doctor’s Prior Authorization Requests for my inhalers, so I could use some help.  What do you know about appealing health insurance coverage decisions in the US? I think there’s something about asking who made the determination and if there were doctors involved, but I can’t remember the details.  Additionally, do you know how to determine when your open enrollment period is? I am at this point wanting to get away from Aetna as quickly as possible, but apparently even if I am paying the premiums myself out of pocket I can’t get blue shield until it’s an open enrollment period??? I don’t really understand that because I know I’ve seen forms asking like “which of your multiple health insurances are you using for this” so I thought you could have multiple forms of health insurance if you wanted. Health insurance makes no sense and I deeply resent everything about this. Especially Aetna. Resenting the fuck out of Aetna tbh

[emmashouldbewriting]

Just a note - Call Center customer service can be WFH. The technology is there for queueing and distributing calls and has been for several years.

Case in point, yesterday, I was on the phone with our medical insurance company, trying to get some claims released from hold because someone told them my husband had a secondary insurance policy (he does not). In the background, I could CLEARLY hear a rooster crowing. Do I think Aetna has replaced their Muzak with nature sounds? Possibly, but roosters would not be likely, unless they have workers falling asleep at their desk, so WFH is more likely.

Oh I know, but for it to be effective you need to really live somewhere with a solid internet/phone connection. It was a huge mess over here at the start of the 'rona despite all that tech. The US is probably cut out for it but the UK was (is?) not lol

[truthwithlight]

hey fellow cripples if you can DO NOT USE AETNA FOR YOUR INSURANCE... [pt: do not use Aetna for your insurance]

this is a load of fucking horse shit. i've been fighting with my insurance for FIVE WHOLE MONTHS [pt: five whole months] to get my AS medication approved. they keep canceling my prior auth. yeah. canceling. not denying! just straight up deleting it and not telling anyone

they tell us we don't have specialty pharmacy coverage, so we talk to our insurance guy and he tells us yes we do it's in our plan! then they tell us cvs isn't a pharmacy in their network! THE INSURANCE IS LITERALLY AETNA CVS [pt: the insurance is literally Aetna CVS]???

they keep directly lying straight to my rheumatologist's medical assistant's face about how the PA process works when half her job is getting PA requests done! i've been living off of sample injectors for the last five months, my doctor is almost out of samples, and the manufacturer has informed them that they're not making samples anymore. the insurance is well aware of this and (before april when they stopped covering that as well) kept telling me to just take humira. i cannot take humira! i get severe injection site reactions! they also know this! it's in my notes!!!

we've sent in appeals, we've gotten both every pa submitted and the appeals expedited, and there's absolutely no word from aetna. just a silently canceled document or "yeah the higher ups aren't budging, sorry, here's [number you've called like 5 times that gets you nowhere]" we get a different story from every single person we talk to

i'm sick of this, my mom is sick of this, my DOCTOR [pt: doctor] is even sick of this, and i just want to be treated like an actual fucking human being and not a case number no one at aetna wants to deal with.

i've been holding myself back from making this post because surely it'll get resolved, right? surely i'm just being bitchy, right?

well my last straw is today when they sent me yet another message saying cvs isn't in their pharmacy network (bullshit) and told me it had to be filled by a local pharmacy i'd never heard of. we call said local pharmacy and they inform us that they're a family owned compounding pharmacy and cannot fill expensive specialty prescriptions like this without LITERALLY GOING BANKRUPT [pt: literally going bankrupt]

the medical assistant we keep having to talk to says that in all her years of having to work through stubborn insurance, she's never had an experience this bad. no patient has ever had this much trouble getting a relatively common prescription filled.

literally the worst experience of my life, it's beyond degrading to be treated like you're the problem because some executive somewhere is deciding that it's better for you to be crippled and in bed all day than approve a single prescription

[dkgwrites]

Healthcare Travel

I’m sitting through a webinar for Point32 (the merged company made from Harvard Pilgrim Health Care and Tufts Healthcare) and they brought up healthcare travel due to the new state specific limitations in female reproductive care after Roe v. Wade was overturned. In a wbur article, it states, “Tufts Health Plan and Harvard Pilgrim Health Care said they will cover airfare, rental cars, and hotel stays for people who can’t get abortions where they live. This follows a similar move from Blue Cross Blue Shield of Massachusetts.”  https://www.wbur.org/news/2022/07/18/massachusetts-health-plans-abortion-travel-expenses

What does this mean for you?

If you live in a state which has limited your reproductive rights, it will be up to your health insurance carrier whether or not they provide this. So if your company’s situs state is Massachusetts (this is likely available in other progressive states, but the majority of my clients are in the NE) and it uses one of the major regional carriers (Tufts, HPHC, or BCBS MA... still waiting for an update from Allways) you will have travel covered for necessary reproductive medical care that isn’t allowed in your state. (Note: There are Blue Cross Blue Shield carriers across the country, and they are not the same, so don’t expect BCBS TX to cover this.) It’s possible Cigna, UHC, and Aetna will offer this dependent on the situs state of the employer, so stay tuned if you are on a national carrier.

Good luck to all and if you have general health insurance questions and I might be able to health, feel free to DM me. I’m a licensed broker.

Get out there and vote, everyone!

[whereisbizzy]

If you cry in the pharmacy it won't guilt your insurance into forking over your meds, but it will get the pharmacist to give you a few until the billion dollar insurance company Aetna decides you can be medicated.

[financguru]

BANK OF AMERICA HEALTHCARE CONFERENCE

Banking/ Byzakria Nadeem

Bank of America held a healthcare conference to discuss the future of healthcare and how it will be impacted by technology.

TheBankof America Healthcare conference is an event that brings together the best and brightest minds in healthcare. It features a wide range of speakers with different expertise, who provide insights on the latest trends in healthcare. The conference is held annually and attracts over 1,000 people from finance, government, academia, and other industries.

It is one of the most highly anticipated events in the healthcare industry. Every year, top executives and decision-makers from across the sector gather to discuss the latest trends and issues facing the industry. So This year’s conference will be no different, with a packed agenda that includes keynote speeches from industry leaders, panel discussions on the challenges facing the sector, and breakout sessions on the latest innovations in healthcare.

Whether you’re a healthcare executive or just interested in the latest developments in the industry, theBank of America healthcare conference is a must-attend event. Whether you are in finance, academia, or any other field related to healthcare, the upcoming conference provides unparalleled insight into the future of healthcare.

This year’s theme is Helping Improve Care Delivery and addresses critical areas such as cost reduction strategies, data analytics technologies for clinical research & drug discovery, and new initiatives aimed at improving care delivery models.

BANK OF AMERICA GLOBAL HEALTHCARE CONFERENCE

Bank of America Global Healthcare Conference is an annual event that brings together healthcare leaders to discuss the latest trends in healthcare.

It is a premier global forum for executives,investors, and policymakers to explore the most pressing issues in health care. It is organized by Bank of America and held annually in various cities around the world.

The conference provides an opportunity for executives from around the world to discuss the most pressing issues in health care, including:

– Technology’s impact on healthcare

– How to address rising drug prices

– The effect of aging populations on healthcare costs

– Strategies for managing chronic disease, including diabetes and Alzheimer’s disease

– Transforming healthcare with technology and data

The conference consists of plenary talks, sessions on new technologies, breakout sessions, discussions of trending topics in the industry, and interactive panel discussions. There are also several networking opportunities for participants to meet with other attendees and attend pre-conference workshops. Attendees also receive access to the newest thinking on key drivers andrisksaffecting both private and public sectors of the industry.

BANK OF AMERICA GLOBAL HEALTHCARE CONFERENCE BOSTON

The Bank of America Global Healthcare Conference Boston is a three-day event. TheBankof America Global Healthcare Conference Boston is one of the most important healthcare conferences in the United States. It is attende-d by leading healthcare professionals from around the world, and provides a forum for discussing the latest developments in the industry.

The conference covers a wide range of topics, including medical research, new treatments and technologies, policy issues, and the business of healthcare. It is an excellent opportunity to network with other professionals in the field, and to learn about the latest innovations in healthcare. If you are involve in any way with healthcare, whether as a provider or a patient, this is a conference that you cannot afford to miss.

There will be over 200 sessions on some of the most significant issues affecting our healthcare system. Topics include health care reform, delivery models, and the latest innovations in health care financing. With speakers from leading hospitals such as Massachusetts General Hospital and Johns Hopkins University Medical Center; health insurance companies like Aetna; and federal agencies like the Centers for Medicare & Medicaid Services, no matter what your interest or level of expertise there is something at this conference for you.

BANK OF AMERICA HEALTHCARE CONFERENCE LAS VEGAS

Bank of America Healthcare Conference Las Vegas is a conference that focuses on the healthcare industry. It is a place for people in the industry to come together and discuss new developments, best practices, andfuture trends.

The Bank of America Healthcare Conference Las Vegas is an exclusive event that only allows a limited number of people to attend. Attendees can learn from some of the top medical professionals in their fields while also meeting with other experts within their own field.

The purpose of theBankof America Healthcare Conference Las Vegas is to bring people together and discuss new developments, best practices, and future trends. With a more hands-on approach than other conferences, this event offers its attendees a number of opportunities to meet with leaders in their field and explore topics in depth.

Attendees will find plenty of workshops, breakout sessions, and networking opportunities as well as receptions sponsored by leading healthcare providers. So Networking events include cocktail receptions at three venues throughout the weeklong program. These evening events offer attendees a chance to mingle over hors d’oeuvres with executives from companies such as UnitedHealth Group Inc., Humana Inc., and Quest Diagnostics Incorporated.