Tag: aetna

Health insurance companies fly in the ointment tactics, and how to win the game.

Posted on by bill
Health insurance companies fly in the ointment tactics, and how to win the game. I was at an insurance seminar yesterday which talked about how to win at reviews and how to prevent insurers from taking advantage of us. Health Insurance companies have a business model that increases profits by using algorithms to deny valid procedure codes or entire claims to boost profits.  Like all of our patients, doctors have expenses and employees who must be paid weekly. In the case of chiropractors, Insurers such have Aetna have repeatedly denied needed evaluations, and codes for regular procedures and created recertification Read More »

Has Aetna been behaving badly? A former Aetna Medical Director tells all.

Posted on by bill
Has Aetna been behaving badly? A former Aetna Medical Director tells all. If you had a bad experience with improperly denied claims or medical procedures by your insurance company, you are not alone.   Insurers often dodge paying claims using terms such as not medically necessary or investigational. If that insurance carrier was Aetna, the problem may be a cultural problem from the executive suites down. There are rules and regulations for how an insurance company behaves in each state.  Unfortunately, not all insurers follow them and worse, many insurers have perfected the art of creating the proverbial “fly in Read More »

The Aetna CVS Merger; good for them, but is it good for us?

Posted on by bill
The Aetna CVS Merger; good for them, but is it good for us? It is no secret that healthcare in the USA is ridiculously priced for most medical services, compared to the rest of the world.  We have witnessed a number of healthcare company mergers that has done everything but reduced the cost of care for us, the consumer. Insurers confuse and frustrate healthcare consumers with complexities such as precertification, tiered networks while reducing our choices of doctor, while they ring up the profits.   Under Obamacare, insurers are limited to using 20 percent of the healthcare premiums for administrative purposes, however, the new math Read More »

NJ health benefits (SHBP) commission openly discriminates against chiropractors and acupuncturists.

Posted on by bill
  NJ health benefits (SHBP) commission openly discriminates against chiropractors and acupuncturists. Good decisions as well as bad decisions are made behind closed doors. State workers who rely on chiropractors and acupuncturists to stay healthier should be alarmed by the recent move by the NJ health benefits (SHBP) commission to treat chiropractors and acupuncturists who are out of network differently than if they were other types of doctors treating patients out of network. If your chiropractor or acupuncturist is an out of network doctor, chiropractic out of network benefits will be limited to $35 while out of network acupuncture fees Read More »