Insurance Company Yields in Fight With Parents of a Tay-Sachs Child [NYT]

[demdiva]

If you've ever wondered if "fighting the good fight" is worth it .... it is.

http://www.nytimes.com/2006/08/24/nyregion/24disease.html?ex=1157083200&en=ac32daf8ca8b4987&ei=5070&emc=eta1

Insurance Company Yields in Fight With Parents of a Tay-Sachs Child
By ANTHONY RAMIREZ
Published: August 24, 2006



Joshua and Elizabeth Margulies at their home in Valley Stream, N.Y., with their son,
Benjamin,who was born with Tay-Sachs disease.

When Benjamin Margulies was born in 2004 at New York University Medical Center, he seemed, at nearly nine pounds, a robust baby.

But after a few months, his parents, Joshua and Elizabeth Margulies of Valley Stream, N.Y., became alarmed. By the time he was nearing his first birthday, their son, whom they call Benjy, could not sit, hold his head up, reach for toys or babble baby noises. And he appeared to be going blind.

Benjy’s condition was diagnosed as Tay-Sachs, a usually fatal genetic disorder for which there is so far no cure and for which his parents said they thought they had been tested and presumably cleared.

What followed was a grueling campaign that lasted for several months to persuade Aetna, the Hartford company that provided the couple’s medical insurance, to pay for what Benjy’s parents contend are life-saving services for their son.

Their efforts were ultimately successful, if not exhausting.

- snip -

Whole story at this link http://www.nytimes.com/2006/08/24/nyregion/24disease.html?ex=1157083200&en=ac32daf8ca8b4987&ei=5070&emc=eta1

[silverweb]

1. I hate Aetna.

When I had Aetna health insurance, they routinely denied ordinary tests and services that were listed as covered. I'd never use them again, given any option.

[prole_for_peace]

2. dammit, my company just switched us to aetna.

i have not heard good things.

[silverweb]

3. The way I understand it...

You have to contest every rejection and eventually they'll pay. But they practically make you take measures a la Grisham's The Rainmaker.

[knitter4democracy]

4. Aetna is one of the worst.

They really are. More and more docs aren't accepting them--if you think they make it bad for patients, just imagine what they do to doctors. It's horrible.