Aetna: you only THINK you're insured
She needs these machines and others because she has spinal muscular atrophy type 2, a disease that weakens muscles throughout her body. She also needs nursing care 12 hours a day.
Without the nurses, her parents, Philomena (aka Phil) and John Rogers, who is the chief information officer at the Commodity Futures Trading Commission, would be in a very tough spot. The outside assistance, covered by their federal Aetna health insurance policy, means better care for Shelby and a more normal life for her parents and three sisters.
But that assistance will not last long. Private duty nursing care will not be covered after Jan. 1, although Aetna is allowing a transition period to March 31. "Please be advised that these changes have been approved by the U.S. Office of Personnel Management," reads a letter from Christopher L. Weinrich, Aetna's director of federal operations. ...
... The Rogerses have used open season to look, without success, for other insurance companies that will cover private duty nurses.
The fact that other companies do not provide the coverage is one reason Aetna decided to dump that benefit, too. "If no one else is offering that benefit, then what you end up getting is adverse selection," Weinrich said during an interview. That occurs when people with a particular health need are drawn to the one company that covers it, which results in that company paying out more than its competitors.
It also means that our nation's health-care system, even for those with coverage, is fraught with holes big enough to push a wheelchair through. Much attention has focused on the 45 million people without health insurance and rightly so. But in the process, the many shortcomings of our market-based insurance system slip by.
This is a top level federal bureaucrat, with premium coverage, but it is not there when he needs it. We need healthcare, NOT health insurance.