A) It covers one exam per year
B) It covers one exam per calendar year
C) Once you've had an exam, you need to wait 365 days before your next exam, or it will cost you $400
If you're Aetna, you ignore common sense and go with choice C).
My wife got an annual physical last summer. Because our kids' school system moved up the start of the school year this year, she got her physical about a month early, so that only 11 months had elapsed since her last exam.
When I saw the bill, I thought it must be a mistake.
The insurance company explained that their annual exam coverage meant that because she hadn't waited 365 days, her exam wasn't covered.
No big deal, I told her, just have your HR department contact them and explain the mistake.
Today, we received this response:
"Since Aetna has processed the medical claim appropriately & according to policy, an exception cannot be made on the claims processing."Now bear in mind, my wife doesn't work for some tiny startup. Her employer is one of the world's most powerful companies. It has nearly 160,000 employees worldwide. And yet Aetna still told my wife's company to pound sand. They did the same thing to this guy.
This isn't the end of the world. After all, it's not like our experience is unique. "Aetna sucks" brings up 5,610 results on Google (versus 139 for "Aetna rocks," a goodly number of which referred to the rocks of Mount Aetna in Greece). And an annual physical is pretty cheap in comparison to being denied heart surgery. Of course, Sean Semon's sad tale took place in 2009. I'm sure they responded to the publicity, right? Oh wait, Sean is still waiting to get on the transplant list.
Look, a blog called "Adventures in Capitalism" isn't going to proclaim the virtues of socialism or demonize corporations. They're called "for-profits," not "Red Cross." But A) applying a policy in a way that seems completely counter to common sense and B) refusing to re-examine the issue even when asked by a Global 1000 corporation seems like pretty bad business.
I'd be happy to hear any alternate explanations that Aetna might have. Right now, it looks like it's using the letter of its contracts to shirk the obligations that any reasonable businessperson would strive to meet.