Tag: aetna

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

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 »

NJ health plan retirees must be wary of the new Aetna Medicare replacement plans; here’s why.

NJ health plan retirees must be wary of the new Aetna Medicare replacement plans; here’s why. If you work for the state of New Jersey and are a NJ health plan retiree and are Medicare eligible , you are no doubt aware that there are changes to your coverage. We have warned our patients about most Medicare Advantage plans, since they are bait and switch vehicles for insurers to give you less than Medicare does, while promising to give you more. In NJ, you can still maintain Medicare as your primary, and Horizon or Aetna as your secondary in retirement.   These Read More »

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

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.

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 will Read More »

Robert Wood Johnson and St. Barnabas healthcare networks merge, is this really good for us, the consumer?

Robert Wood Johnson and St. Barnabas healthcare networks merge, is this really good for us, the consumer? Recently, I read that the reason for high healthcare costs are the few super utilizers of care. While it may be true that a few people (roughly 5% of patients) use a lot of care, few physicians in private practice have been responsible for these costs, yet the drug companies and hospitals continue to profit immensely from cases like these. Obamacare has had the effect of creating more mergers, as more doctors struggle to compete. The end result is that the larger the Read More »