OPINION: Real-world health insurance math doesn’t add up

Introduction

Aetna’s had a lot to say lately about how business is good. The company disclosed last week that it made $458 million in profits this spring, and said it expected to make more money this year than executives previously thought possible. The firm also signaled it set aside three quarters of a billion dollars from policyholders to buy back shares of its own stock instead of paying more claims. But a few days before that, Aetna’s CEO got a real-world understanding of just how inadequate some of the company’s policies are.

And thanks to Twitter, the rest of us got a better understanding of how U.S. health insurers are able to profit so handsomely from the inadequate policies they sell, especially to students.

A significant part of Aetna’s revenues come from its student health plan business. The company contracts with many colleges across the country to provide coverage to students. Trouble is, those policies typically have low annual and lifetime limits — as was discovered recently by Arijit Guha, a 31-year-old graduate student at Arizona State University who’s been diagnosed with colon cancer. Guha was paying $400 a month for a policy that had a $300,000 lifetime limit. It didn’t take long for his care, including surgery and chemotherapy, to exceed that.

Facing a growing mountain of bills and the very real possibility of having to file for bankruptcy, Guha and his friends decided to set up a provocatively named website — poopstrong.org — and to use Twitter and other social media to raise money to pay the claims Aetna was denying.

Tweeting as Poop Strong, Guha soon drew the attention of a customer service representative at Aetna and, ultimately, the big guy himself, CEO Mark Bertolini.

Here’s an abridged version of how it went down:

Poop Strong: @Aetna’s 4th qtr profit up 73%: “it continued to benefit from low use of health care.” Helps they can ensure low use.

Aetna: @Poop_Strong We care about our members. We want you to be empowered to be healthy and make informed decisions…Please know we’re here to answer your questions and discuss your concerns.

Poop Strong: @AetnaHelp @Aetna That’s so sweet you want me to be empowered. Does [Mark Bertolini] care to empower me by paying my $118k and counting in bills?…The thing is, I’ve needed you for the last 6 mos. Not for “support” and “to discuss concerns” but to pay my bills.

Another thread by some of Poop Strong’s friends drew out Bertolini:

Bag of Moons: @mtbert You, sir, have blood on your hands. Man up & pay for @Poop_Strong’s treatment, & for others like him. You don’t need the $, they do

ItsLerama: My bud @Poop_Strong, a PhD student w Stage 4, was shamefully kicked off his insurance. @Aetna. Btw congrats on the $10.6M CEO salary @mtbert!

Mark T. Bertolini: @Its Lerama @aetna We did not kick @Poop_Strong off his insurance. We are on the phone with him now to find a solution to his financial issue.

Nhojelttil: @mtbert @ItsLerema @Aetna @Poop_Strong You did, in fact, do just that. Glad if you’re fixing it now. A little bad PR goes a long way, huh?

Mark T. Bertolini: @nhojelttil That’s not the case. His benefits did not cover anything. We paid hundreds of thousands in $ already. A call is all it takes.

Poop Strong: @mtbert @nhojelttil “A call is all it takes?” Does that mean if I call you you’ll graciously offer to pay my bills? That’d be nice….Moreover, do you think it’s morally justifiable to offer a flawed insurance product that doesn’t cover catastrophes?

Poop Strong: @mtbert @nhojelttil I will have insurance again as of mid-August not be/c you were kind enough to eliminate lifetime caps on your own…But because you were forced to do so due to the new healthcare law (which on Aug. 1 made lifetime caps unlawful for student plans). Why did you offer such shi**y plans to begin with?

Poop Strong: @mtbert @nhojelttil True or False?: I am in this situation because your company offers a crappy product.

Poop Strong: @mtbert @nhojelttil And you could do more to help if you were more interested in helping than profit-maximizing.

Mark T. Bertolini: @Poop_Strong False. Why do you think the premium was so low? Do you look at your policy limits when u buy other insurance (auto)?

Poop Strong: @mtbert Are you suggesting I had a choice in the matter? Health insurance exchanges don’t arrive until 2014.

Poop Strong: @mtbert Moreover, isn’t it morally reprehensible that you offer such a limited product? One that caps benefits so low?…One day’s salary for you is $30,000. Surely you can spare that?

As it turned out, Bertolini eventually did decide he could spare that — and more. He tweeted to Guha that Aetna would pay “every last penny” of his bills and added, “The system is broken, and I am committed to fixing it.”

So this story may have a happy ending — for Guha, at least, if his treatments are successful and Bertolini keeps his word. But what about all the other students, all the other people who can’t draw a health insurance company CEO into a conversation?

As mcpeed commented on an ABC online story about Guha: “That’s great and I’m glad for this student. But what about all the other people affected by this grossly unfair policy who don’t have Twitter accounts and followings? Is the CEO of Aetna going to pay for all of their treatment too? Are they still going to lobby against the Affordable Healthcare Act which outlaws lifetime caps? I expect the CEO is a nice guy… but his company policies suck.”