Thursday, February 18, 2010

Okay, where was I?

Math problems.

(First, though, we started out on our trip yesterday morning but turned back. The farther north and the higher up we drove, the faster and thicker the snow fell and it just wasn't worth risking an accident to continue. We stopped at the grocery for panko crumbs and catfish on the way home – a pretty good trade for an out-of-town trip, if you ask me!)

Night before last, my brain was buzzing (and keeping me awake) trying to figure out just how my health insurance company arrived at my new premium rate.

Last time I wrote about Aetna, I was ranting and raving about having to endure two rate increases within a calendar year. Thanks to the intervention of the West Virginia Health Insurance Commissioner employee who has been helping me, not only has my premium been reduced, but I'm getting a refund check for overpayment of premiums. Lots of overpayment. (Frankly, I'll believe it when I see it – the check hasn't arrived yet.)

I know what the original premium quote was, I know what the actual original premium was (higher than the quote), I know what the rates following two increases since I became a member have been and I know what the percentage of increase was. What I still can't figure out is what number they started with to come up with the new number.

Oh, well. It's significantly less than I've been paying and I'll be able to tuck the refund check back into my health savings account, to cover the office visits my insurance doesn't.

Now here's the important part: My premium was increased right off the bat because I was taking an antidepressant at the time of my application. However, I wasn't taking it for depression. An off-label use of Wellbutrin is weight loss. (The same drug under a different brand name also is used for smoking cessation.)

In order to reduce my premium, I went off the Wellbutrin. But guess what? I'm obese, so the rate remained the same (and the nice lady at Aetna said now I had a real incentive to lose that weight!).

Insurance premiums are increased on a percentage basis, and when the second 15 percent increase in a year was announced, I contacted the insurance commissioner, which started the ball rolling. And the ball ended up in my favor, because Aetna isn't allowed to charge higher premiums due to obesity.

I'm sure they knew that, but did they ever expect anyone to dig deeper? No, and even if someone did, they got to invest the money for a while.

When I first learned about the refund, I wanted to write letters to the editors of every major newspaper, call investigative journalists across the land, let MSNBC and CNN know about my situation. Since I still don't have the check, I've kept quiet. Heh. Last time I talked to the insurance commissioner specialist working on my case, I asked him if he was going to follow up for others in my situation and he said, "First I want to make sure you get your money. Then, yes, I'm definitely looking into other areas where Aetna is overcharging."

So I don't have to put my story out there for the world to see, which is a relief. But both of you readers get to know all the gory details, aren't you lucky?


JourneyBeyondSurvival said...

Good job.

Do NOT get me started on insurance. I will have a HORRIBLE, terrible, no good, very bad day if I even get started.

Here's to your insurance commissioner specialist!

denise said...

I'm SO impressed that you had the perseverance to do this! I hope you get your check soon. It would be very nice to see a "real person" win over the insurance industry!

D said...

I say you send out a press release once you finally get that check. A little awareness-raising after all of your hard diligent work is definitely in order.