It's open enrollment - Aetna versus Horizon BCBS

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JoniB
JoniB Member Posts: 346
edited November 2017 in Employment, Insurance, and Other Financial Issues

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.


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  • Meow13
    Meow13 Member Posts: 4,859
    edited October 2017

    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.

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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited October 2017

    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.


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  • scaligirl
    scaligirl Member Posts: 74
    edited November 2017

    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.

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  • JoniB
    JoniB Member Posts: 346
    edited November 2017

    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.

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  • edwards750
    edwards750 Member Posts: 3,761
    edited November 2017

    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

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