August 20, 2012--Aetna and Me

Aetna is my medical insurer. I recently learned that they are lowering their reimbursement rates so that a routine test I had last year for which they paid $300, for this year they will cover only $150 of the total bill. When I called to protest, they told me that this was because the average cost of that test in New York City has been reduced enough to justify this. If you believe that . . .

And now I received the following letter from them:

Your plan is getting a rebate from Aetna. (Bold type in the original.)

"Really?" I asked Rona who was reading the letter out loud. "They'll be sending me a refund check?"

"Don't get your hopes up, the letter says that your plan, as opposed to you, is getting the rebate."

"Because?"

"Because, they say"--

Sometimes our medical costs are higher than we projected. Sometimes they are lower. Under the health care reform law, plans must spend a minimum on medical costs and quality improvement activities. When our costs are less than the minimum, we pay rebates, regardless of the amount.

"Huh? I am totally confused. Is this because . . . ?"

"It's because, as they say, of the 'health care reform law.'"

"The Affordable Care Act? Obamacare?"

"None other."

"Read that again. Are they saying, as they put it, that their medical costs are lower than allowed by Obamacare for so-called quality improvement activities, they are sending out checks?"

"Again, not to you; but to your former employer who continues to provide your coverage."

"I get it. They are spending more than the 15 percent the law allows for administrative expenses and of course profit and so they have to do this rebating. In fact it has nothing to do with 'quality improvement activities,' whatever that means."

"That would be my read," Rona said.

"I thought that maybe they are having to do this since they are clearly spending much, much less on health care reimbursements, as the amount they are paying for my blood tests would suggest."

"Though the doctor didn't reduce what he charged and you had to write him a check to cover the difference."

"All true. But one more thing," I said, "There are many people who pay for their own coverage. If they have a policy with Aetna I assume they will get a personal rebate check. I wonder if to them Aetna's letter will give credit to President Obama for getting legislation passed that requires this."

"Dream on. Though I don't know why the Obama people aren't taking political credit for this. It might overcome some of the intentional misinformation about the Affordable Care Act being put out there by Romney and Ryan and motivate more people to see the direct benefit of Obamacare to them and their families."

"I agree. I still don't know why they have been so inept at this. Taking credit for doing a good thing."

"In the meantime, I'll bet we see more shenanigans from Aetna. They must hate having to do this."