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Today is a (Mostly) Good Day!

As many of you know, I have been working a compressed schedule in order to provide support to my father as he battles Leukemia. For those who have been through these types of illnesses, you know how many ups and downs there can be. For me it has been a difficult and yet also joyful 7 weeks since his diagnosis. I have come to appreciate many things as a result of this illness - I have spent much more time with my father and that has been wonderful.

What has not been wonderful is finding myself, on behalf of my father, stuck in an insurance mess. We are stuck between a provider - Albany Medical Center - and his insurance carrier - Aetna. My clients are insurance companies exclusively and I have always loved this work. The people I deal with on a daily basis at my client companies are one of the things I like most about my job.

However, being on the other side - a consumer with a problem - has been eye-opening. We are left making choices from among bad alternatives. Despite years of paying premiums, he can’t get the care he needs at the facility he wants because after the last open enrollment, the contract between Aetna and the hospital was terminated in February - just days before his diagnosis. He would not have enrolled in the Aetna plan had he known in November that the contract with Albany Med would be terminated during the plan year. No one in this area would knowingly take a plan that doesn’t include that hospital. But he didn’t - and couldn’t - know, he signed up, the contract was terminated and now it is his care that suffers. Was there a meeting of the minds?  Was there a contract where Aetna agreed to provide the services he chose at the facilities, including Albany Medical Center, they showed as participating at the time he agreed to pay the premium? 

The phone calls and exchanges of paperwork are endless, but we make little or no progress in getting what he needs and what we believe he should be entitled to. I juggle these with my work for clients. I try to spend as much time as possible with him and to participate actively in his treatment plan. There is no time to put the plan on hold while we work through these insurance issues. As a consumer it is maddening. As a daughter it is devastating. As an insurance compliance attorney it raises new questions for me about how regulation works and doesn’t work. But those are questions I don’t have time for now - I have work to do in this system both professionally and personally. Life doesn’t wait for regulatory issues to be resolved. So I will keep plugging in the system we have to get what my father needs and I’ll keep enjoying the time I am spending with him - even if a lot of it is spent talking about how frustrated we both are at the way he is stuck in a dispute he had nothing to do with. It is a (mostly) good day!