Insurance woes

Aud
Aud Member Posts: 479 Member
edited March 2014 in Colorectal Cancer #1
I recently got a letter from my insurance company (Aetna) that Pennsylvania Hospital will no longer participate in Aetna network as of 2-15-2010 (where I had my surgeries, radiation treatment, scans, follow up visits, which I am still currently doing, and even my counseling sessions). This is a kick in the gut.

I need to find out more information. Pennsylvania Hospital is a good hospital and I trust my surgeon. The thought of changing a whole team of doctors scares me. I have follow up appointments in May, June. My surgeon wanted to follow me closely because of scar tissue he wanted to keep a close eye on. I had a PET scan that was clear; waiting on the CEA. don't know if the PET scan will indeed be covered since I had it done 3-2-2010 and in the letter, Aetna states that they "will honor authorizations for covered services issued ....for treatment scheduled at this hospital (had the PET at HUP which is in the same hospital system as Pennsylvania Hospital) after the network termination date, provided that: (1) the hospital agrees to the same contractual terms and conditions that existed prior to the termination, and (2) the authorization is still valid when the treatment occurs." I just really hate this.

I just received this mail tonight, too late to call anyone now, so I'll start making phone calls tomorrow.
I wonder if other teaching hospitals are affected.

I have things to be grateful for. 1. I'm finished with radiation treatment; this could have happened in the middle of it. 2. I have insurance coverage. Which actually leads me to some righteous fury. None of us should even have to worry about all this.
Lisa, I know this isn't as serious as your insurance woes, but what the he11?! Insurance companies really do call the shots, don't they?

Comments

  • AnneCan
    AnneCan Member Posts: 3,673 Member
    #2
    Audrey,
    I am sorry to hear
    Audrey,

    I am sorry to hear this; it must be really frustrating + upsetting for you.
  • lisa42
    lisa42 Member Posts: 3,625 Member
    #3
    Aud
    Hi Aud,

    It's just different than my issues is all, Aud. It's still huge. You may want to find out if your current hospital/dr. group isn't going to be fully covered anymore, will they at least be partially covered? If not, you probably should start shopping now. Get a good referall from your current onc, surgeon, radiation team, etc. I hope it doesn't come down to that, but it sounds like it might be the case. Sorry. Yes, insurance- can't get through without them, but sometimes you can't get through in the way you want to (or need) with them.
    Sorry, my dear. Insurance denials and more limitations seem to be the wave of our new present and future.

    Take care,
    Lisa
  • abrub
    abrub Member Posts: 2,174 Member
    #4
    Insurance advise
    Check to see if you may continue as in network at Penn Hospital through a "continuity of care" provision. In some cases, in some areas, an insurer may not require you to change providers during major medical care.

    It's certainly worth looking into.

    You can also try negotiating with your providers directly, to see how they can help you with your issues.

    Good luck. Having cancer is bad enough without having to endure all this other stuff.
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    #5
    Aud
    I'm sorry to hear that but like you said, you didn't have to change mid-treatment. I had a reverse situation at first. Sloan wasn't part of my network at first. I paid out of pocket with consultations with my onc and then went to an in-network hospital for treatments. It cost a bit more but I got the care I deserved.
    Yes, insurance companies do call the shots....
    -p
  • porkchopqueen
    porkchopqueen Member Posts: 37
    #6
    Ask to fill out a
    Ask to fill out a Continuation of Care form. You have your doctors sign it and send it in to the insurance company and if they approve it, all okay. Can't hurt to try. I did it and got good news on one doctor, seems he was the only one I could see, so they had to accept. You know what the answer will be if you don't ask.

    Good luck, no one needs extra stuff to worry about when we already have all the other things going on.
  • Aud
    Aud Member Posts: 479 Member
    #7
    Don't always believe what you read....even (esp.) from Ins. co.
    When I called my insurance company, they said that Pennsylvania Hospital is not in network with Aetna POS but IS in network with Aetna PPO. I have POS. When I called Pennsylvania Hospital/HUP (Hospital of University of Pennsylvania), I was referred to the Managing Director of Account Resolutions, who deals directly with Aetna, and he said that the letter Aetna sent out to it's subscribers was an error, that Penn/HUP is still in network with Aetna (including POS) and that the termination of contract has to do with Aetna's worker's comp program (who knew?)and not Aetna's POS plan.
    There would be no way to know this just by reading the letter that Aetna sent.
    Lesson learned: Don't fret until you have something you KNOW you have to fret about.
    And even then...
    Needless to say, I saved this man's number for future reference.
    Thanks for listening.
    Aud
  • lisa42
    lisa42 Member Posts: 3,625 Member
    #8
    Aud said:

    Don't always believe what you read....even (esp.) from Ins. co.
    When I called my insurance company, they said that Pennsylvania Hospital is not in network with Aetna POS but IS in network with Aetna PPO. I have POS. When I called Pennsylvania Hospital/HUP (Hospital of University of Pennsylvania), I was referred to the Managing Director of Account Resolutions, who deals directly with Aetna, and he said that the letter Aetna sent out to it's subscribers was an error, that Penn/HUP is still in network with Aetna (including POS) and that the termination of contract has to do with Aetna's worker's comp program (who knew?)and not Aetna's POS plan.
    There would be no way to know this just by reading the letter that Aetna sent.
    Lesson learned: Don't fret until you have something you KNOW you have to fret about.
    And even then...
    Needless to say, I saved this man's number for future reference.
    Thanks for listening.
    Aud

    a happy ending!
    Aud,

    I'm happy to hear this & that it was just a mistake. A pretty maddening mistake- jeez!
    Well, glad to hear you'll be okay and can continue care with who you want to.

    Take care,
    Lisa
  • lisa42
    lisa42 Member Posts: 3,625 Member
    #9
    Aud said:

    Don't always believe what you read....even (esp.) from Ins. co.
    When I called my insurance company, they said that Pennsylvania Hospital is not in network with Aetna POS but IS in network with Aetna PPO. I have POS. When I called Pennsylvania Hospital/HUP (Hospital of University of Pennsylvania), I was referred to the Managing Director of Account Resolutions, who deals directly with Aetna, and he said that the letter Aetna sent out to it's subscribers was an error, that Penn/HUP is still in network with Aetna (including POS) and that the termination of contract has to do with Aetna's worker's comp program (who knew?)and not Aetna's POS plan.
    There would be no way to know this just by reading the letter that Aetna sent.
    Lesson learned: Don't fret until you have something you KNOW you have to fret about.
    And even then...
    Needless to say, I saved this man's number for future reference.
    Thanks for listening.
    Aud

    posted twice by mistake- now
    posted twice by mistake- now can't get this one to delete.
  • AnneCan
    AnneCan Member Posts: 3,673 Member
    #10
    Aud said:

    Don't always believe what you read....even (esp.) from Ins. co.
    When I called my insurance company, they said that Pennsylvania Hospital is not in network with Aetna POS but IS in network with Aetna PPO. I have POS. When I called Pennsylvania Hospital/HUP (Hospital of University of Pennsylvania), I was referred to the Managing Director of Account Resolutions, who deals directly with Aetna, and he said that the letter Aetna sent out to it's subscribers was an error, that Penn/HUP is still in network with Aetna (including POS) and that the termination of contract has to do with Aetna's worker's comp program (who knew?)and not Aetna's POS plan.
    There would be no way to know this just by reading the letter that Aetna sent.
    Lesson learned: Don't fret until you have something you KNOW you have to fret about.
    And even then...
    Needless to say, I saved this man's number for future reference.
    Thanks for listening.
    Aud

    Fabulous! I am so happy for
    Fabulous! I am so happy for you; we cancer surviors don't need added stress. I am so sorry you had this worry + I am glad you have a happy ending to this tale!
  • tootsie1
    tootsie1 Member Posts: 5,044 Member
    #11
    Aud said:

    Don't always believe what you read....even (esp.) from Ins. co.
    When I called my insurance company, they said that Pennsylvania Hospital is not in network with Aetna POS but IS in network with Aetna PPO. I have POS. When I called Pennsylvania Hospital/HUP (Hospital of University of Pennsylvania), I was referred to the Managing Director of Account Resolutions, who deals directly with Aetna, and he said that the letter Aetna sent out to it's subscribers was an error, that Penn/HUP is still in network with Aetna (including POS) and that the termination of contract has to do with Aetna's worker's comp program (who knew?)and not Aetna's POS plan.
    There would be no way to know this just by reading the letter that Aetna sent.
    Lesson learned: Don't fret until you have something you KNOW you have to fret about.
    And even then...
    Needless to say, I saved this man's number for future reference.
    Thanks for listening.
    Aud

    Whew!
    I'm so glad this turned out okay! Whew!

    *hugs*
    Gail

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