Word: aetna
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Shortly after his courtroom fall, Goodrich was told he had stomach cancer. It was then that he found himself launched upon a three-year ordeal of battling not just the disease that would ultimately kill him but also Aetna U.S. Health Care, the nation's largest health insurer. As required, he first approached doctors in his plan. Conceding that they didn't have the expertise to treat his rare form of cancer, leiomyosarcoma, they referred him to specialists outside the plan. He bounced back and forth between clinics and Aetna bureaucrats who challenged his use of out-of-plan doctors...
Some good and bad news on managed care: Aetna U.S. Healthcare said last week that it would allow its customers to appeal coverage denials to an external review board. Other HMOs, like United Healthcare, are expected to follow suit. But many HMOs are raising average co-payments for prescriptions $5 to $15. Tip: stick with generic drugs...
...handwriting is on the wall for HMOs, and it isn't hard to read: A jury in San Bernardino, Calif., ordered Aetna U.S. Health Care of California to pay $120.5 million -- a record sum for an HMO suit -- to the wife of a man who couldn't get the company to cover his experimental cancer treatment and died. "The jury's statement is clear: Many people are just fed up with HMOs," says TIME medical columnist Christine Gorman...
...bureaucracy, hurdles and information gaps that many HMOs have set up between patients and doctors in order to protect their corporate bottom lines have infuriated huge segments of the population. The Aetna verdict is the latest indication that, when given the chance, citizens are willing to vent their frustrations big time. "If I were anyone affiliated with running an HMO, I'd be worried about this development," says Gorman. For the moment, the Aetna verdict is an aberration in the sense that most people cannot sue their HMOs for large, punishing damage claims -- federal law forbids it. "The only reason...
...from their sweethearts. It was from their HMOs. Thanks to increasing medical costs and decreasing federal reimbursements, taking care of patients over 65 is not so profitable a business as it was in the early 1990s. So as of Dec. 31, more than 90 HMOs across the U.S.--including Aetna, Humana and Oxford--will stop serving Medicare customers in certain regions around the country...