groundhog day with aetna


I saw the envelope in my mailbox from Aetna today.  And I knew, I just knew based on the kind of envelope it was what the contents were.


You got it. Groundhog day health insurer style.

At the end of this year Aetna is discontinuing my current individual subscriber plan.  I have Aetna Leap Specialty. Or I think that is the name. I am not on the “exchange”, I am an INDIVIDUAL Atena subscriber who pre-dates the Affordable Care Act.

Aetna quit the healthcare exchange this summer in several states, including the one I live in, Pennsylvania.  The pointed to “financial stress” Bloomberg News on August 15, 2016 quoted the CEO as saying :

“The vast majority of payers have experienced continued financial stress within their individual public exchange business,” Aetna Chief Executive Officer Mark Bertolini said in the statement. “Providing affordable, high-quality health care options to consumers is not possible without a balanced risk pool.”

Can we go back to my original thought about how the health insurance industry cannot be reformed if you don’t start with the actual companies?  If the health insurance companies aren’t forced to change and the pharmaceutical companies aren’t forced to change, crap is just going to keep happening. Because why? They don’t care about their customers and their subscribers, they only care about their profit margins. Without actual reform, this stuff will just keep happening.

Look at Mylan which as a drug company I think sucks anyway.  The Wall Street Journal just broke more news on the upcharging epi pen sellers:

Mylan’s EpiPen Pretax Profits 60% Higher Than Number Told to CongressCompany applied 37.5% tax rate onto the profits it revealed to a House committee hearing last week

Updated Sept. 26, 2016 3:01 p.m. ET

When Mylan NV’s chief executive testified before a congressional committee last week about steep price increases on its lifesaving EpiPen drug, House members badgered her to provide more evidence for the company’s claim that its profit was $100 for a two-pack of the injectors, despite a $608 list price.

The committee members left unsatisfied. Now it appears they were right to seek clarity.

In response to questions from The Wall Street Journal, Mylan now says the $100 figure presented by CEO Heather Bresch included something the company didn’t clearly convey to Congress—taxes. The company substantially reduced its calculation of EpiPen profit by applying the statutory U.S. tax rate of 37.5%.

Without the tax-related reduction, Mylan’s profit on the EpiPen two-pack would be closer to $160, or 60% higher than the figure the company gave Congress. The company sells about 4.1 million EpiPen two-packs in the U.S., analysts said.


So back to Aetna….and I do hope they have to appear on a Capitol Hill Hot Seat like Mylan soon. (but I digress).

Ever since the Affordable Care Act came to be, Aetna pretty much monkeys with my coverage annually. You know, like Groundhog Day.

For the past three years in particular, Aetna has informed me some time from August through I guess October that they are discontinuing whatever  health insurance plan I have with them as an individual subscriber NOT on the Exchange.

That letter arrived again today. It also had a handy non-discrimination notice in the envelope and translation to Sudanese and other languages. They want to make sure all their subscribers know they are screwed whether they are on the Exchange or not.


They provided me with a toll free number to call. I called. I got a recording after losing three minutes of my life from an Aetna “partner” (code word for more outsourcing) saying I could talk to them on October 15th.

aetna-2 aetna-3

So now I get to add to my annual stress levels when it comes to health insurance.

So now this will be added to the Aetna headache posts like:

update on healthcare drama, or can you hear me screaming

It is indeed health insurance Groundhog Day.  Oh gee golly whillikers I can hardly wait! I have already lost a few hours today but come October I get to do it again.  And as a breast cancer survivor who needs continuity of care, I end up spending hours on the the phone making sure I get adequate coverage.

It’s not so easy and I have to check and make sure every single doctor I see within the University of Pennsylvania Healthcare System is on the plans I look at.  I have a cancer team. I am not some 25 year old whose greatest worry is the annual OB/GYN exam and can I get birth control covered. I am a 52 year old breast cancer survivor still in active treatment because hello I take cancer drugs.

I mean WTF Aetna??? Time to start contacting the man in the ivory tower CEO Mark Bertolini and President Karen Lunch again.

I already started by Tweeting my displeasure and the @AetnaHelp tweetie birds are all a twitter literally.  But how can they help me? I know from past similar conversations they can’t tell me why I have Groundhog Day on an annual basis with my plans.  They are like Aetna’s social media Rockettes, they kick up their virtual legs, but that is about it.

I am really not so difficult.  All I want is continuity.  I want to pay my premium and be able to see my doctors all year round, not just 2/3 of the year with 1/3 of the year feeling my blood pressure rise as I realize I have to dance for health insurance again.

If you live in Pennsylvania and are an individual insured, you do NOT have many options.  I can tell you from my friends that the exchange under the Affordable Care Act does NOT offer much in the way of actual choice, let alone plans that are actually worth paying for.  That leaves Aetna and Independence Blue Cross.

I had Keystone HMO before Obamacare and before breast cancer when I was on a corporate plan and then when I was covered on my ex’s small business policy. When he left I had to get individual insurance.  As an individual Keystone / Independence Blue Cross they rejected me for coverage because…wait for it…I had answered yes to the question did I ever have irregular periods. I remember speaking to the underwrtiter at the time and asking her if she had ever had an irregular period and did she answer the question honestly or lie.   She did not like that very much.

That is how I ended up with Aetna.

Aetna pre-Obamacare was easy.  It was affordable and I had the coverage I needed, including all my Penn doctors.

Now I have an annual headache of Aetna Groundhog day.  Then trying to get used to new plans, new charges, their “tier” system.  Basically all my doctors are really good ones so it I pay the top tier of pricing.   Suffice it to say, I pay well above a $50 co-pay.

But looking at Keystone Health Plan East, I see that Independence Blue Cross still doesn’t really want to cover individual subscribers. Oh yes, they have the nice and fluffy Obamacare-speak, but they still do not seem to want to cover individuals.

No one does.  You have this big healthcare revolution that has been instituted during 8 years of Obama as President and the healthcare system in this country is as big a hot mess as ever.

I have never, ever gone without health insurance. I have always kept myself insured. But now at 52, I am a five year self-employed breast cancer survivor and my options seem to shrink annually. By law I have to have health insurance and by need I have to have health insurance. But health insurance companies want to offer us less and less and charge us more, or find a way to dump the state you live in.

Me going on the Obamacare exchange is not a viable option, especially if I was to keep seeing the doctors who saved my life and God forbid I get a recurrence.   Oh yes, sure supposedly they can’t cancel you for a pre-exisiting condition like cancer, but oh yes they can try other ways to do JUST THAT.

That is what I think this annual Groudhog Day with Aetna is about. They do not value me or my timely paid, never missed insurance premiums.  They are trying to find a way to get rid of us pesky self-insureds. THAT is what is really going on in my opinion.  If they valued me and my business, I would just get a renewal notice like I used to before Obamacare.

But I don’t.  I get a letter telling me so sad too bad I am in cancellation city at the end of 2016. That I have to start the process ALL OVER AGAIN.  But I can’t talk to anyone NOW about what my options are, I have to wait until October 15 and then talk to some other person employed in an Aetna outsourced area. And if I need help between now and then, hell I know the routine, you go to call centers in the Phillipines where they can’t deviate from a script and can’t help you and often refuse to transfer you to a state-side call center even if they are supposed to transfer you if you know to request that.

Today I decided to reach out and touch elected officials in the United States Senate.  I chose the senators I can see putting the most pressure on Aetna: Sens. Elizabeth Warren (D-Mass.), Bernie Sanders (I-Vt.), Ed Markey (D-Mass.), Sherrod Brown (D-Ohio) and Bill Nelson (D-Fla.)

How did I figure them out?

See these articles:

Aetna’s Health Reform Blueprint: Invest in Public Health

The health insurance giant will be focusing its efforts on investment in social programs.

By Kimberly Leonard | Staff Writer Sept. 26, 2016, at 9:12 a.m.

Aetna, the health insurance behemoth that recently backed away from Obamacare, is focusing its efforts on setting the blueprint for what it sees as the next step to health care reform under a new administration.

Through research and grants the firm’s Aetna Foundation is investing in projects aimed at reducing chronic disease like expanding healthy eating options or constructing walkable neighborhoods. The company, says Aetna chairman and CEO Mark Bertolini, intends to demonstrate that the quality of a person’s health has less to do with the health care they receive and more to do with how they live.


Senators send 2nd letter to Aetna CEO following unanswered questions — 5 key points

Several Democratic senators sent a second letter to Aetna CEO Mark Bertolini, demanding answers as to why the payer left the Affordable Care Act exchanges, according to Morning Consult.

Senate Democrats Again Question Aetna’s Exchange Withdrawal

CT Mirror: Senators press fight with Aetna over quitting ACA exchanges

Washington – A group of liberal senators and Aetna CEO Mark Bertolini continued their battle Friday, with the lawmakers accusing the insurance executive of avoiding their questions about Aetna’s decision to quit 11 health insurance exchanges.

“We are disappointed by your failure to respond in a meaningful way. Your lack of cooperation does not mollify our concern that Aetna appears to be attempting to force the Justice Department into approving its controversial merger by threatening access to coverage for millions of Americans,” wrote Sens. Elizabeth Warren, D-Mass., and Bernie Sanders, I-Vermont, and three other senators.

The senators had written Bertolini on Sept. 8, asking the Aetna chief about his decision to withdraw from 11 Affordable Care Act exchanges after the Justice Department challenged Aetna’s proposed merger with Humana. The senators asked Bertolini to respond to 12 questions, including “what exact costs Aetna will incur now that the Justice Department has challenged the merger” and how much it will cost the company if the merger is ultimately blocked.


So I called the offices of these U.S. Senators.  First their staffers all asked me why I wasn’t calling Pennsylvania Senators Casey and Toomey.  I asked them if they had met the people tasked with representing Pennsylvanians.

First there is Bob Casey whose office still hasn’t responded to a fairly simple query I made oh around 2007 or 2008.

Then there is Pat Toomey, who seems to prefer women be seen and not heard and not have the right to choose.  If I was Toomey’s ideal woman I would be silent, barefoot, preggers and in the kitchen.  Only I am 52, a breast cancer survivor with a brain in her head and who has had a hysterectomy. I am not his ideal conservative breeder, in other words.

So I gave these Senators’ offices a call this afternoon and told them what it was like being an Aetna insured NOT on the exchange and NOT on a corporate plan, but as an individual.

(here is the link to the letter these senators sent

Not all the Senators had staffers to answer their phones.  Some just had voice mail and Florida Senator Bill Nelson’s phone just rang and rang and rang.

But I did get to speak to people in Senator Warren and Senator Sanders offices.  I just wanted them to know what it was like to be an individual in Pennsylvania dealing with Aetna and their annual Groundhog Day.

Will it do any good? I do not know.  All I do know is what happens to me and millions of others annually is not fair.

Some will say life is not fair and to them I say nice view point, but no I am not accepting this health insurance Groundhog Day every year.

Aetna, your subscribers deserve better.

And PS Aetna as of September 16 was protesting the fact they lost out on three-year contracts to manage long-term care for Medicaid beneficiaries.     I find that ironic all things considered.

I would love to be able to bill Aetna the time I have to spend not -working and being my own health care advocate.   Is anyone starting a class action suit against Aetna? Hit me up via this blog if it happens.

Read about Aetna Complaints HERE  and HERE or just look at their Facebook page.




About carla

Writer, blogger, photographer, breast cancer survivor. I write about whatever strikes my fancy as I meander through life.
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2 Responses to groundhog day with aetna

  1. Caralyn says:

    Hi Carla, I’m having a similar Groundhog Day experience with Aetna currently as a breast cancer patient undergoing my second mastectomy. Aetna refused my waiver for continuity of care to use my reconstructive surgeon I used for my first mastectomy & I”m now on the hook for a significant medical bill. Thank you so much for writing your blog & calling Aetna out for their shameful treatment of breast cancer patients.

    • carla says:

      I am so sorry! I switched to blue cross this year because Aetna only offered PA residents one crappy “bronze” plan and told me I could just pick new doctors.

      Wishing you the best…keep fighting…do not settle for sub par treatment

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