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Aetna從拒癌症而被🥶罰款2600萬到現在連性別💃🏻手術都覆蓋!

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Aetna同意擴大性別確認手術的覆蓋範圍

還記得幾年前Aetna因拒賠癌症費用而被索賠2600萬元的事情嗎?

當時,我們都覺得Aetna不好,我們都不太推薦這家保險公司。

但自從它家被CVS收購之後,感覺就像“脫胎換骨”似的,給人煥然一新的感覺,Aetna現在就連性別確認都覆蓋!大家可以看到這個天差地別的變化了吧~

還記得當年拒保人是自己籌款(大約有10萬)到MD 安德森癌症中心 – M.D. Anderson Cancer Center進行治療。這是多麼無助可悲的事情啊,自己明明買了保險,心中該踏實才對,誰知道竟然遭到拒賠,之後還牽連出官司。

「點看」美國最新癌症醫院排名

兩年前,匹茲堡的一名醫護人員科拉·布拉納(Cora Brna)得知自己的保險無法支付她計劃進行的生殖器再分配手術所帶來的隆胸手術而感到震驚。

30歲的變性女性Allison Escolastico想要隆胸手術已有十年了。到2019年,她最終認為自己的保險公司Aetna會為這筆錢付款,只是發現它認為該程序是整容手術,並非醫學上必需的,並且拒絕承保。

Escolastico女士說:“我從我的案件中知道,這不是化妝品。”她說:“我知道我必須為此奮鬥。”

現在,Escolastico女士的手術計劃於2月進行。她與倡導跨性別權利的非營利組織跨性別法律防衛和教育基金會以及代表原告的大型律師事務所Cohen Milstein Sellers and Toll一起工作,她和一小部分跨性別婦女說服Aetna進行調查,以證明他們可以證明自己的程序。在醫學上是必須的。

要獲得資格,這些婦女將需要證明自己患有持續的性別不安,經歷了一年的女性化激素療法並獲得了心理健康專家的推薦。

CVS Health子公司Aetna宣布,該保險公司現在將在其大多數商業計劃中涵蓋肯定性別的隆胸手術。這一變化是Aetna,跨性別法律辯護和教育基金會(TLDEF),Cohen Milstein Sellers&Toll律師事務所與幾名跨性別Aetna成員之間合作的結果。

該更新使隆乳的覆蓋範圍與跨性別患者的其他外科手術(例如,乳房切除或性別重新分配手術)的覆蓋範圍政策保持一致。 Aetna說,隆胸程序將包括醫生的轉診,患者性別不安的記錄以及至少一年的激素治療的完成。

來源:https://www.nytimes.com/2021/01/26/health/transgender-aetna-health-insurance.html?auth=-google1tap

「點看」乳癌成因,症狀,治療資訊

Aetna因拒患癌病人的理賠申請而被賠償2600萬美元!

Click here for the English version

奥克拉荷马州 — 陪審團要求醫療保險公司安泰(Aetna)向奥克拉荷马州一家庭支付2550萬美元的賠償,理由是該親屬在其去世前一年間,被Aetna拒絕其放射療法承保的要求。奥克拉荷马州報導員說,週一陪審團發現,安泰的醫生沒有用足夠的時間來審查Orrana Cunningham的病例。

OKLAHOMA CITY — A jury has instructed health insurer Aetna to pay an Oklahoma City family $25.5 million for denying a relative’s claim for coverage for a type of radiation therapy the year before she died. The jury on Monday found that Aetna doctors didn’t spend enough time reviewing Orrana Cunningham’s case, The Oklahoman reported.

The jury ruled that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham, who had nasopharyngeal cancer.

Aetna is considering whether to appeal. Company attorney John Shely said the insurer tries to do the right thing.

「點看」免體檢人壽保險

“If it’s in our control to change, that’s what we’re going to do,” Shely said. “Aetna has learned something here.”

An Aetna doctor denied Cunningham coverage for proton beam therapy in 2014, deeming it experimental, and two other in-house doctors reviewed and upheld the decision.

Doug Terry, the family’s attorney, noted that the Food and Drug Administration had approved proton beam therapy, which is also a treatment covered by Medicare. He alleged that Aetna denied coverage for financial reasons and that its doctors were unqualified, overworked and biased when making decisions.

Court records show that one doctor complained to the insurer about having to review more than 80 cases a day.

「點看」紅藍卡計劃

Cunningham’s family had to mortgage their home in Meeker to pay for the therapy in Texas. “We have exhausted all our resources on top of our normal living cost,” her husband Ron Cunningham, wrote on GoFundMe page before his wife died.

Orranna Cunningham, 54, died in May 2015

“My wife, her goal, was to make this fight,” said Ron Cunningham. “Her comment was, ‘If we can save one person and stop Aetna from doing what they traditionally do on every claim, it was worth the battle.'”

According to her obituary, the couple was married 28 years.

來源: https://www.cnn.com/2018/11/10/health/aetna-verdict-oklahoma-orrana-cunningham/index.html

Aetna團體醫療保險計劃

由上述個案可見,Aetna並不好,所以遭來巨額的賠償要求。所以我們不太推薦Aetna的醫療保險計劃。

再者,從下圖可見,就連Aetna它們自己家的網站上,最新的一份醫保價格資料都只是去到2016年,由此可見它們也並不重視團體醫保計劃的產品,這讓我們更加不願意把它推薦給客人。

Aetna紅藍卡計劃

但是,自從Aetna被CVS收購後,就推出了十分吸引人的PPO計劃 – Aetna的紅藍卡老人計劃

以下是我們其中一個參加了Aetna紅藍卡計劃的客人的藥物申請紀錄。

從中可見,此藥物申請單中包含好幾種不同的藥物種類,無需Copay,藥物也是不用錢的,那就是全免費!

這就是我們推薦它家的老年人紅藍卡計劃的原因!