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Aetna从拒癌症而被🥶罚款2600万到现在连性别💃🏻手术都覆盖!

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安泰同意扩大性别确认手术的覆盖范围

还记得几年前Aetna因拒赔癌症费用而被索赔2600万元的事情吗?

当时,我们都觉得Aetna不好,我们都不太推荐这家保险公司。

但自从它家被CVS收购之后,感觉就像“脱胎换骨”似的,给人焕然一新的感觉,Aetna现在就连性别确认都覆盖!大家可以看到这个天差地别的变化了吧~

还记得当年拒保人是自己筹款(大约有10万)到MD 安德森癌症中心– MD Anderson Cancer Center进行治疗。这是多么无助可悲的事情啊,自己明明买了保险,心中该踏实才对,谁知道竟然遭到拒赔,之后还牵连出官司。

「点看」美国最新癌症医院排名

两年前,匹兹堡的一名医护人员科拉·布拉纳(Cora Brna)得知自己的保险无法支付她计划进行的生殖器再分配手术所带来的隆胸手术而感到震惊。

30岁的变性女性Allison Escolastico想要隆胸手术已有十年了。到2019年,她最终认为自己的保险公司Aetna会为这笔钱付款,只是发现它认为该程序是整容手术,并非医学上必需的,并且拒绝承保。

Escolastico女士说:“我从我的案件中知道,这不是化妆品。”她说:“我知道我必须为此奋斗。”

现在,Escolastico女士的手术计划于2月进行。她与倡导跨性别权利的非营利组织跨性别法律防卫和教育基金会以及代表原告的大型律师事务所Cohen Milstein Sellers and Toll一起工作,她和一小部分跨性别妇女说服Aetna进行调查,以证明他们可以证明自己的程序。在医学上是必须的。

要获得资格,这些妇女将需要证明自己患有持续的性别不安,经历了一年的女性化激素疗法并获得了心理健康专家的推荐。

CVS健康子公司Aetna宣布,该保险公司现在将在其大多数商业计划中涵盖肯定性别的隆胸手术。这一变化是Aetna,跨性别法律辩护和教育基金会(TLDEF),Cohen Milstein Sellers&Toll律师事务所与几名跨性别Aetna成员之间合作的结果。

该更新使隆乳的覆盖范围与跨性别患者的其他外科手术(例如,乳房切除或性别重新分配手术)的覆盖范围政策保持一致。 Aetna说,隆胸程序将包括医生的转诊,患者性别不安的记录以及至少一年的激素治疗的完成。

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

「点看」乳癌成因,症状,治疗资讯

Aetna因拒患癌病人的理赔申请而被赔偿2600万美元!

点击这里查看英文版

奥克拉荷马州— 陪审团要求医疗保险公司安泰(安泰)向奥克拉荷马州一家庭支付2550万美元的赔偿,理由是该亲属在其去世前一年间,被Aetna拒绝其放射疗法承保的要求。奥克拉荷马州报导员说,周一陪审团发现,安泰的医生没有用足够的时间来审查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.

「点看」免体检人寿保险

“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.

「点看」红蓝卡计划

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.

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

Aetna团体医疗保险计划

由上述个案可见,Aetna并不好,所以遭来巨额的赔偿要求。 所以我们不太推荐Aetna的医疗保险计划。

再者,从下图可见,就连Aetna它们自己家的网站上,最新的一份医保价格资料都只是去到2016年,由此可见它们也并不重视团体医保计划的产品,这让我们更加不愿意把它推荐给客人。

Aetna红蓝卡计划

但是,自从Aetna被CVS收购后,就推出了十分吸引人的PPO计划– Aetna的红蓝卡老人计划

以下是我们其中一个参加了Aetna红蓝卡计划的客人的药物申请纪录。

从中可见,此药物申请单中包含好几种不同的药物种类,无需Copay,药物也是不用钱的,那就是全免费!

这就是我们推荐它家的老年人红蓝卡计划的原因!