Hello. I'm 29 years old and just had a brain tumor removed in December '05. My Wife and I are covered by an Aetna HMO and had pretty good coverage for the surgery and hospital stay ( I work full time and have health coverage through my company)

The problem is that in 2006 I am on the same health insurance plan ( My portion to pay went up about $25 per check for 2006) but I just found out that in 2006 the plan went from covering most services in 2005 with a $25 co-pay to making us pay 10% of those same services in 2006.

I'm currently getting radiation treatment for a piece of the tumor they were unable to remove and we just got a bill for a CAT Scan that was done in January for $1200, when we paid 25$ for that same test back in December.

Help.. does anyone have any advice or know if there is anything I can do about this.. do I have any rights?

I'm so unfamillar with all of the policies and health insurance procedures.. up to this point I've never been to the doctor more than once a year..

thank you so much for any help / advice you have.

JP..

Hello. I'm 29 years old and just had a brain tumor removed in December '05. My Wife and I are covered by an Aetna HMO and had pretty good coverage for the surgery and hospital stay ( I work full time and have health coverage through my company)

The problem is that in 2006 I am on the same health insurance plan ( My portion to pay went up about $25 per check for 2006) but I just found out that in 2006 the plan went from covering most services in 2005 with a $25 co-pay to making us pay 10% of those same services in 2006.

I'm currently getting radiation treatment for a piece of the tumor they were unable to remove and we just got a bill for a CAT Scan that was done in January for $1200, when we paid 25$ for that same test back in December.

Help.. does anyone have any advice or know if there is anything I can do about this.. do I have any rights?

I'm so unfamillar with all of the policies and health insurance procedures.. up to this point I've never been to the doctor more than once a year..

thank you so much for any help / advice you have.

JP..


You really do not have any "rights," unfortunately.

I don't have much experience with the Aetna HMO, but I'm pretty knowledgable about their other products (PPO's, Managed Choice, etc). It's likely that your employer opted for a cheaper plan this year, thus passing more of the financial responsibility on to you. Aetna can not just "change" your plan that drastically-- your employer had to elect for the change, or at least agree to it.

I'm sorry that I don't have more information, or even positive news.

Good luck. :)

Suggest you get a copy of the plan from your employer so you know exactly what you have. Then call Aetna customer service and ask them to explain the bill you received. Without all the details it is hard to give any advice.
Customer serviec is always the best way to start.

All medical insurances are passing more costs onto the consumer in order to keep the premium increases minimal. At times the employers don't have much of a choice. I've seen my deductibles/co-pays increase this year.

I agree, best course of action is to get a copy of the benefits from the employer/human resources/benifits department and contract customer service. I have familiarity with HMOs, PPOs, POS, and indemnity plans (I've had them all over the years).

The good news here is that from what you've said about your new plan, you should also have what's called an Out of Pocket Maximum. Therefore you should only be paying 10% up to a certain dollar amount, and once you meet that amount, there should be 100% coverage for the rest of your plan year. Almost all plans like the one you are describing have this type of cap, and so you should not have to pay 10% indefinitely. Something to look into -- good luck!

The good news here is that from what you've said about your new plan, you should also have what's called an Out of Pocket Maximum. Therefore you should only be paying 10% up to a certain dollar amount, and once you meet that amount, there should be 100% coverage for the rest of your plan year. Almost all plans like the one you are describing have this type of cap, and so you should not have to pay 10% indefinitely. Something to look into -- good luck!

We have atnea HMO also and my husband had cancer last year also. Our out of pocket for 9 days at Moffitt and surgery was $750 and co pays to specialists is $35 and Primary is $15 also Chemo was $35 per treatment. Our out of pocket deductable was $1500 and after that we paid nothing for the rest of the year.