It's open enrollment - Aetna versus Horizon BCBS
I currently have Horizon BCBS of NJ PPO as my insurance plan. My choices at work are Horizon or Aetna. However, this year we are switching from the Horizon PPO plan to Horizon Direct Access. All my NJ doctors are in Direct Access so no problem and I can use any doctor in another state that is part of a BCBS PPO - which my NY doctors are. I never needed authorization for an MRI and have had one every year since 2007 when my first breast cancer was detected. My second cancer was detected by MRI. I was hesitant to switch to Aetna even though less money because I was worried that they would not pay for my MRI. Now I find that with Horizon Direct Access I will need an authorization for an MRI. I went looking for documentation to determine when Horizon considers an MRI medically necessary and have I don't think my dense breasts and two cancers qualify me - but I feel I have a better chance with Horizon than Aetna. I don't love Horizon but I feel the evil I know is better than the evil I don't know. So I would like to know people's experiences with these two insurance companies. How did you find dealing with them as a breast cancer patient? Did you have problems with authorizations, claim adjustments, etc.? I appreciate everyone's input.
Comments
-
Well, I too will be given different choices during November. It will definitely cost more, I need breast MRIs once a year because I have very dense tissue. Anytime I see authorization necessary I see red tape.
-
I have Aetna Open Access. I think they've been very good during this whole ordeal. They've certainly paid a huge amount on my behalf.
They do require pre-auth for MRI's and some of my drugs. I haven't had any denials. Their clinical bulletins are available online and outline when they will or will not cover a specific test or procedure.
-
Stay away from Aetna is my asvice. I just changed to someone else during my open enrollment. Aetna has been fighting all my treatment claims and now I've got a lawyer. They do not care about your health, only money.
Example: covered lab tests in March at facility X no problem. Get huge bill for lumpectomy from exact same facility and suddenly it is out of network. Arbitrary lie to try to get out of paying. As IF I needed this added stress.
-
Scaligirl - so sorry to hear of your insurance problems. That's the last thing you need. Which Aetna plan did you have? I've had similar situations with BCBS.
-
It’s an ongoing battle with most insurance companies unfortunately. We have BC/BS of Tennessee. We didn’t have payment issues with my DX other than they wanted us to pay upfront and I refused. BC said don’t pay anything until we received our EOB so that’s what we did. They insisted they had access to their website which they did but I stood my ground and said I’ll pay when I get it in writing. What were they going to do repossess my biopsy?
Persistence pays off. We have won several tug of wars with BC about my DH’s procedures. I filed an appeal and won.
It’s a pain in the neck to have to make a zillion phone calls to get action but it pays off.
Most of our friends have either Cigna or BC.
Diane
Categories
- All Categories
- 679 Advocacy and Fund-Raising
- 289 Advocacy
- 68 I've Donated to Breastcancer.org in honor of....
- Test
- 322 Walks, Runs and Fundraising Events for Breastcancer.org
- 5.6K Community Connections
- 282 Middle Age 40-60(ish) Years Old With Breast Cancer
- 53 Australians and New Zealanders Affected by Breast Cancer
- 208 Black Women or Men With Breast Cancer
- 684 Canadians Affected by Breast Cancer
- 1.5K Caring for Someone with Breast cancer
- 455 Caring for Someone with Stage IV or Mets
- 260 High Risk of Recurrence or Second Breast Cancer
- 22 International, Non-English Speakers With Breast Cancer
- 16 Latinas/Hispanics With Breast Cancer
- 189 LGBTQA+ With Breast Cancer
- 152 May Their Memory Live On
- 85 Member Matchup & Virtual Support Meetups
- 375 Members by Location
- 291 Older Than 60 Years Old With Breast Cancer
- 177 Singles With Breast Cancer
- 869 Young With Breast Cancer
- 50.4K Connecting With Others Who Have a Similar Diagnosis
- 204 Breast Cancer with Another Diagnosis or Comorbidity
- 4K DCIS (Ductal Carcinoma In Situ)
- 79 DCIS plus HER2-positive Microinvasion
- 529 Genetic Testing
- 2.2K HER2+ (Positive) Breast Cancer
- 1.5K IBC (Inflammatory Breast Cancer)
- 3.4K IDC (Invasive Ductal Carcinoma)
- 1.5K ILC (Invasive Lobular Carcinoma)
- 999 Just Diagnosed With a Recurrence or Metastasis
- 652 LCIS (Lobular Carcinoma In Situ)
- 193 Less Common Types of Breast Cancer
- 252 Male Breast Cancer
- 86 Mixed Type Breast Cancer
- 3.1K Not Diagnosed With a Recurrence or Metastases but Concerned
- 189 Palliative Therapy/Hospice Care
- 488 Second or Third Breast Cancer
- 1.2K Stage I Breast Cancer
- 313 Stage II Breast Cancer
- 3.8K Stage III Breast Cancer
- 2.5K Triple-Negative Breast Cancer
- 13.1K Day-to-Day Matters
- 132 All things COVID-19 or coronavirus
- 87 BCO Free-Cycle: Give or Trade Items Related to Breast Cancer
- 5.9K Clinical Trials, Research News, Podcasts, and Study Results
- 86 Coping with Holidays, Special Days and Anniversaries
- 828 Employment, Insurance, and Other Financial Issues
- 101 Family and Family Planning Matters
- Family Issues for Those Who Have Breast Cancer
- 26 Furry friends
- 1.8K Humor and Games
- 1.6K Mental Health: Because Cancer Doesn't Just Affect Your Breasts
- 706 Recipe Swap for Healthy Living
- 704 Recommend Your Resources
- 171 Sex & Relationship Matters
- 9 The Political Corner
- 874 Working on Your Fitness
- 4.5K Moving On & Finding Inspiration After Breast Cancer
- 394 Bonded by Breast Cancer
- 3.1K Life After Breast Cancer
- 806 Prayers and Spiritual Support
- 285 Who or What Inspires You?
- 28.7K Not Diagnosed But Concerned
- 1K Benign Breast Conditions
- 2.3K High Risk for Breast Cancer
- 18K Not Diagnosed But Worried
- 7.4K Waiting for Test Results
- 603 Site News and Announcements
- 560 Comments, Suggestions, Feature Requests
- 39 Mod Announcements, Breastcancer.org News, Blog Entries, Podcasts
- 4 Survey, Interview and Participant Requests: Need your Help!
- 61.9K Tests, Treatments & Side Effects
- 586 Alternative Medicine
- 255 Bone Health and Bone Loss
- 11.4K Breast Reconstruction
- 7.9K Chemotherapy - Before, During, and After
- 2.7K Complementary and Holistic Medicine and Treatment
- 775 Diagnosed and Waiting for Test Results
- 7.8K Hormonal Therapy - Before, During, and After
- 50 Immunotherapy - Before, During, and After
- 7.4K Just Diagnosed
- 1.4K Living Without Reconstruction After a Mastectomy
- 5.2K Lymphedema
- 3.6K Managing Side Effects of Breast Cancer and Its Treatment
- 591 Pain
- 3.9K Radiation Therapy - Before, During, and After
- 8.4K Surgery - Before, During, and After
- 109 Welcome to Breastcancer.org
- 98 Acknowledging and honoring our Community
- 11 Info & Resources for New Patients & Members From the Team