Health Insurance

[Marlene]

We have an option to change health care insurance and I was wondering if anyone has United Health Care as their provider and what your experience has been. We current have Aetna and they have been pretty much paid for all of John's treatment without any delay or appeals. John is in a partial stable remission but relapse, secondary disease from treatment is always in the back of our minds. The only med he's on is testosterone and he sees his doc 2x year. (pretty good after 8 years)

The reason for the switch is because he has a new job and the upfront contribution is very small but with higher deductible versus a pretty hefty premium we pay now. If I do the math, it's obvious to go with United, but if it means getting an insurer who's policy is to try and not pay for anything, then is it worth it?

Any experiences would be appreciated.

Thanks....Marlene

[Neil Cuadra]

Marlene,

To figure out how to spend the least money, the key is quantifying "try and not pay for anything". If you get a copy of their coverage details perhaps you can find out how their coverage compares for treatments John might have, including transfusions and phlebotomy, whether their drug formulary covers Exjade, Cytoxan, and other drugs you know by name, whether they mention aplastic anemia, and what coverage they have for "cancer" in general. You don't really know what treatments John might need down the road but this should give you an idea how they cover the types of treatments most common for bone marrow failure diseases.

You should check if John's doctors are covered by their plan. You can probably find out with a phone call to United, and perhaps double-checking with his doctors.

Make sure that there isn't a "pre-existing condition" restriction. Since he's had continuous insurance coverage you'd expect him not to have to wait 6 months (or some other interval) for coverage of SAA to kick in, but you should definitely confirm that.

From what I've read, insurance companies may routinely deny some claims but change their minds if you appeal the determination. They pretty much have to stick to their stated coverage so knowing what's covered and being a squeaky wheel will do patients a lot of good.

Cost savings may be the #1 criteria but there are also the factors like fast claim processing and having claim information available online that go into "customer satisfaction". For that you can use health care rating information, for example the Virginia Health Information site, to see ratings and comparisons. Which brings up the question of which insurance-rating sites are best. The National Committee for Quality Assurance is probably a good one. Otherwise, I don't know of sites to recommend, but I know there are site like Consumer Health Ratings that list or compare the rating sites.

Maybe it would be worth subscribing to the health site of Consumer Reports. Consumer Reports rated PPO health plans in their September 2009 issue and gave rankings of #33 to Aetna Life Insurance (nationwide) and #39 to UnitedHealthcare (nationwide) if that's the company you are referring to. The two plans had identical ratings, all Cs and Ds, except for "phone customer service" where Aetna got a C and UnitedHealthcare got a D. These scores were based on reader surveys.

[Marlene]

Thanks Neil,

Those are some great ideas for me follow-up on. I think we are spoiled. Before John started treatment, his case went before the board to get approval to treat him and they basically gave the go ahead to treat with no restrictions. I will never forget when they called to tell me treatment at Hopkins was approved. The agent basically said they usually do for these fatal diseases. Then she realized that she used the word "fatal" and was so apologetic. So we never were denied a procedure, med or doctor. And, the company I retired from has a very comprehensive plan.

[Neil Cuadra]

Marlene,

If it were me, given that blanket approval, I'd be tempted to stick with Aetna even if I could save money by switching. We were very lucky that my wife had no trouble with approvals, from ATG all the way through transplant, and even when we went for an out-of-state second opinion. There's a lot of peace of mind in avoiding insurance hassles.

[Marlene]

Yeah, I know what you mean. John and I are wondering if we are letting "fear" get in the way of this decision. The answer is yes but it's a valid concern given his history. We never would have given this second thought in the past...we would switched in a heartbeat. And, there's no guarantee my retiree benefit will continue from year to year.

I think what ever we choose, we'll be ok in the long run. We are fortunate to have this choice.

[mausmish]

We have United Health Care consumer driven option and have had no problems whatsoever so far. I was dx'ed 6 months ago and have racked up a lot of medical claims. I was approved with no hassle for a BMT. I've also had calls from insurance company nurses asking if I had questions or concerns and even offering health tips. I don't know if plans differ but so far, ours has been great.

[Marlene]

Thanks so much for the feedback. I hope to get details of his plan so we can compare and decide.

M

[CindyW]

I think you can find opinions and reviews on many sites. It seems like the big companies seem to get good ratings from consumer reports and other polls and surveys. When we were shopping around for insurance, we made a list of all the treatments, doctor appointments, prescription medicines and other medical costs for an average year. It took time but we plugged in all the numbers for each plan and were able to make a more informed decision on what plan to choose.