Looking for someone with Aetna or Humana/Cofinity health ins. experience

[Krischaser]

Hi I have narrowed down my health insurance choices to Aetna and Humana. We are a family of five with a 11, 7, and 2 year old. I am buying it on our own since our work does not provide health benefits. Anyone have any experience with any of these companies? Thanks!

 

[Ali]

I just got Aetna in February through DH's work. So far they have denied every prescription we have submitted, even though we have been using the meds for 3 to 5 years, because they didn't see a step therapy through their company. Why should we have to go to meds that didn't work to prove to the insurance they don't work?

Our doctors were all on the plan, and a surprise hospital ER visit was actually not too expensive.

So, in general if you just need a plan for minimal support it is ok. If you have extended medical issues and need lots of prescriptions then I am not so sure.

 

[2Monkeys]

I work in a psych office, so have a little knowledge about insurance. For mental health at least, we do not see good coverage for our patients with either of these. However, all plans are different even if they come from the same company.

You need to look at the specifics of the policy for what your needs are. Copays, coinsurance, deductibles, well child care, hospitalization, meds, etc. You should also look at pre-exisiting condition clauses. Since this is not an employer sponsored plan, they may be able to exclude pre-existing conditions for a period of time (depending on your state laws).

Is Blue Cross an option? Their coverage tends to be better, but perhaps more expensive.

 

[dhardawa]

I work for Humana so I have had their insurance now for 7 years. The only thing offered to employees is a high deductible plan (which sucks), but I have had no issues with claims in that time.

 

[MrsJackSparrow4Life]

I work in healthcare and my company uses Aetna. As long as I do my homework before hand and find a doctor or facility that is associated with my company or in-network I have no or very little out of pocket expenses.

I currently use their Preventative care PPO. All preventative care (annual exam, vaccines, etc) is covered 100%; no deductible or copay. They also give me $800 fund each year to spend on non-preventative care for my daughter and myself (I think this is increased to $1200 for a family). This $800 rolls over each year so if you don't use it, you don't lose it. If you do use it, they take it out of your deductible as well, so the $2500 deductible goes down to $1700. I have not used much of my fund, so I currently have $2900, which means if anything big were to happen to me or my daughter I wouldn't have to worry about my deductible at all.

 

[princessmorgan]

We have Aetna and I think every plan is different, so you need to check out all of that with your employer. We used to have a PPO and then we switched to a Health Fund, because DH wanted to give it a try. We don't have any extreme medical issues, but I have been surprised that Aetna has covered some prescriptons such as excema creams and nausea medication for pregnancy at 100%. When my first DD was born we had an issue about coverage for a neonatal dr, but I fought it and appealed and they denied it. However then they ended up paying for it. We haven't had issues with them and I like them better than United Healthcare, but not as much as Blue Cross Blue Shield. But that also could have been due to our coverage.

 

[poohguys]

We used to have BCBS at work and then my company switched to Aetna. The perscription plan is better, but we now have a higher co pay and a deductable. We do not have to get referals to go to specialist which is nice, but I believe that varies by what paln you have. Aetna has been okay. They only "problem" we have had is DH's doctor that he has been going to since he was a teenager dropped them. I have seen other doctors drop them as well.

 

[shortbun]

It really depends on the plan. I had Aetna for several years and loved everything about them. My union/employer agreement was for the 'good stuff.' Recently, I had a $95,000 hospital claim. My share was $15. I never had them decline a med even when a doctor said there might be a problem. That said, I'm sure they had a cheaper plan that covered less. You REALLY have to do your research, compare prescription coverages, major medical, psychiatric care, copays and so forth.

 

[Tinknalli]

Make sure that the facilities you use are in network. The hospital I work for is not in network for either of these. We will submit the claims, the insurance will process as out of network and we bill the patient for everything not paid by them. We don't do any write offs or discounts that they request.

Have to agree that the best insurance is BCBS. They have the larest network and most places accept and are in network for BCBS if they accept insurance at all.

 

[Krischaser]

Happy Easter everyone and I appreciate all the comments. I am having to decide tonight. With Aetna I am looking at a $3000.00 deductible per person or $6,000 for the family. Copay for office, specialist, and urgent care. But lab work is paid after the deductible. Deductible first of 500 for prescriptions besides generic. I am hoping that most medicine we use is generic like z-pack, amoxicillin, the usual for strep throat mostly or sinus infections. With Humana I am looking at 2500.00 deductible per person or 7000.00 per family. Everything else is the same except they offer 500 per person to cover lab work or xrays. We have three active boys. We average one urgent care visit a year for either stitches or an x-ray. There is a $60.00 per month difference in cost between the two. It is crazy that the cost is as much as our mortagage payment. We also have a babysitter payment too. This is not sponsored by our employer at all--all costs are ours Blue Cross is way too expensive. I would be paying the same amount but no copays for doctor visits. Must pay deductible first. Blue Cross is what our old employer used to participate in but now our new employer offers nothing. (Owners sold business) It is just so sad and frustrating.

 

[kiki02]

Happy Easter everyone and I appreciate all the comments. I am having to decide tonight. With Aetna I am looking at a $3000.00 deductible per person or $6,000 for the family. Copay for office, specialist, and urgent care. But lab work is paid after the deductible. Deductible first of 500 for prescriptions besides generic. I am hoping that most medicine we use is generic like z-pack, amoxicillin, the usual for strep throat mostly or sinus infections. With Humana I am looking at 2500.00 deductible per person or 7000.00 per family. Everything else is the same except they offer 500 per person to cover lab work or xrays. We have three active boys. We average one urgent care visit a year for either stitches or an x-ray. There is a $60.00 per month difference in cost between the two. It is crazy that the cost is as much as our mortagage payment. We also have a babysitter payment too. This is not sponsored by our employer at all--all costs are ours Blue Cross is way too expensive. I would be paying the same amount but no copays for doctor visits. Must pay deductible first. Blue Cross is what our old employer used to participate in but now our new employer offers nothing. (Owners sold business) It is just so sad and frustrating.

krish; how much are the monthly premiums on it? i thought blue cross (where we are) was one of the lowest.

 

[2Monkeys]

Remember that if you have to pay your premiums all on your own, they are tax deductible as a medical expense. That won't help you much now, but will when you do your taxes next year. Make sure and save EVERY receipt from medical/prescription/eye doctor/dentist - all of that is tax deductible (as long as your expenses are more than 7.5% of your adjusted gross income, which it sounds like they would be if your premiums are that high). I would look at your tax return from this year and see what 7.5% would be, then you'll know if it is deductible. You could then change your withholding allowances so you would have less money taken out of your paychecks to help pay the premiums.

So sorry you are having to pay this all out of pocket.

 

[Krischaser]

Hi everyone. The monthly costs are 798.00 per month or 729.00 per month. Couple that with my mortgage and babysitting fees and there goes our paycheck!