I was more then a little surprised yesterday to get a bill in the mail from Pinnacle Health for a partial payment on some blood work I'd had done this summer as part of my annual physical. Why surprised? Because I have Aetna Insurance through my employer and according to the plan I have they are supposed to cover physicals 100%. So, of course, I called Aetna. The representative I talked to asked if I had any pre-existing issues and I told her I did not. Her response was that my health provider had billed the blood work as Lipidemia blood work, rather then routine blood work, the kind of work they always do to check cholesterol and glucose. She asked if I had any pre-existing conditions and I said "nope, I'm very healthy." At her suggestion, I called my health provider to get to the source of the problem. I was not very happy with the information I received. You see back in 2011, during a routine physical, my triglycerides were 2 points higher then what is considered normal. My doctor felt that I should have the blood work run again in 6 months just to make sure everything was normal, which I did, and it was. Except for that one blip my triglycerides have been fine ever since. However, that one blip gave me pre-existing status, at least as far as Aetna was concerned.
When I asked my provider why the last blood work was billed to Aetna as a Lipidemia test I was informed that to do so would be considered fraud. You have no idea how stunned I was to discover that a 2 point blip in my triglyceride lever in 2011 is going to stick with me for life. From now on, no matter how good my blood work is, Aetna is going to say I have a pre-existing condition. As a result, rather then pay 100% of the routine physical costs, Aetna is only going to pay a percentage. Excuse me, Aetna, don't shit on people just to feed your bottom line! What is really sad was my provider informed me that I was like a lot of other people. One little blip and you have a pre-exiting condition. It may never show up again, but Aetna doesn't care. What they do care about is saving themselves $23 bucks on a blood test that is no different from the standard blood test given as part of a routine physical. My provider told me Highmark Blue Cross does the same thing, shit on their customers (that's not exactly how she put it, but it's what she meant). Their idea of fair coverage is to nitpick and nickel and dime you so there's as little expense to their bank account as possible. They're in the business of making money, not defining fair. Do they care what your out of pocket expense is? Hell no. They see you as either a good investment or a bad investment. A good investment is an individual who pays more while they pay less. A bad investment is one with no pre-existing conditions. A good investment has regular payroll deductions with out any costs. A bad investment gets sick. Because of their inherent preference to greed rather then fair coverage, Aetna sucks.
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