Medical Mutual or Aetna? A perspective from NW Ohio
Dear CORE members and all STRS retirees,
In the next week or so you will be receiving Health Care information on coverage and premiums for 2006. Most of you have a choice between Aetna or Medical Mutual. I am a CORE member, just like the rest of you, and I do not represent either insurance company. I am interested in getting the most for my premium dollar and I know you are also.
I have been helping an elderly STRS couple in our Lima area straighten out their 2004 hospital and short term nursing home bills that Aetna kept dragging their feet in paying the bills. In my research to help this couple, I have learned some important money saving facts about the two insurance companies. These facts are also important to retirees under 65 as well.
Medical Mutual will give you better coverage for the premium dollar (and at a lower premium if you are younger than 65) than Aetna does. Medical Mutual has more in-network providers in Northwestern Ohio than Aetna; therefore, more choices and probably better health care for the member. For example, in Lima, a town of 45,000, there was only one Aetna in-network nursing facility; Medical Mutual had three. That means the member has a better chance of getting into a network facility. That translates to lower costs for the members.
This is what happened to the couple I helped. He had been hospitalized with a serious illness and needed an special nursing home placement (isolation). The only Aetna in-network facility was full, so another one was chosen. The other facilities that were in-network for Aetna were Dayton (1 hour away) and Columbus (1-1/2 to 2 hours away). This retiree's specialists could not care for him in a facility so far away.
According to a phone call I made to Aetna last week, Aetna will make no exceptions to their rules of in- and out-of-network, even if there is no in-network facility in the area, or the only one they have is full and will accept no new patients. That means that this retiree had already paid his $500 deductible and out-of-pocket $1,500 expense and THEN had to pay an additional $1,000 deductible for out-of-network, and THEN pay 50% of the remainder of the bill for a 10 day stay!
If this retiree had been with Medical Mutual, he would have had no second deductible to pay and would have paid 20% of the remainder instead of 50%. This is another interesting fact: if this retiree had had Medicare A instead of of STRS Aetna, he would have paid ZERO ( 0 ) for the nursing home care.
How is that for equivalent? But Mr. Russell at STRS says that STRS covers their over 65-year-old retirees with equivalent coverage to Medicare A. Look over the information carefully -- call both Aetna and Medical Mutual for a provider handbook for your area.
Aetna's book of providers is not nearly as complete as that of Medical Mutual. Aetna does not even list nursing homes and some other specialities. So the ill member or a stressed spouse must have the presence of mind to call Aetna to see if providers that may be needed immediately are in the network.
Ask questions of Aetna, Medical Mutual and STRS and then decide what is best for you.
-- Shirlee Zerkel
10/11/2005
Thank you, Shirlee, for a real eye opener! KBB
Molly Janczyk adds:
I do know that in Cols. many Dr.s refuse Aetna due to non payment or slow payment. I also suggest Med Mutual but as Shirlee says: Be sure to ck in advance if your caregivers and facilities are IN NETWORK and that you are precertified BEFORE admissions. She is correct: Med Mut has only SOME facilites in network in each area. In cols. there are several for each end of town vs. the one for Aetna in an area Shirlee mentions. IF you go to ones out of network, you will pay addt'l deduc. and add'tl out of pockets. ALWAYS CK FIRST! Folks get confused because Medicare alone allows any facility; STRS insurance providers allow certain ones. You can get a list of the ones near you by calling. Also the facility will call and find out for you as well. If out of network it is an add'tl $1000-1500 you must pay. What STRS means is: comparable coverage for IN NETWORK! Medicare has no certain network facilities. With STRS we do have to ck up front for precerts and network.
In the next week or so you will be receiving Health Care information on coverage and premiums for 2006. Most of you have a choice between Aetna or Medical Mutual. I am a CORE member, just like the rest of you, and I do not represent either insurance company. I am interested in getting the most for my premium dollar and I know you are also.
I have been helping an elderly STRS couple in our Lima area straighten out their 2004 hospital and short term nursing home bills that Aetna kept dragging their feet in paying the bills. In my research to help this couple, I have learned some important money saving facts about the two insurance companies. These facts are also important to retirees under 65 as well.
Medical Mutual will give you better coverage for the premium dollar (and at a lower premium if you are younger than 65) than Aetna does. Medical Mutual has more in-network providers in Northwestern Ohio than Aetna; therefore, more choices and probably better health care for the member. For example, in Lima, a town of 45,000, there was only one Aetna in-network nursing facility; Medical Mutual had three. That means the member has a better chance of getting into a network facility. That translates to lower costs for the members.
This is what happened to the couple I helped. He had been hospitalized with a serious illness and needed an special nursing home placement (isolation). The only Aetna in-network facility was full, so another one was chosen. The other facilities that were in-network for Aetna were Dayton (1 hour away) and Columbus (1-1/2 to 2 hours away). This retiree's specialists could not care for him in a facility so far away.
According to a phone call I made to Aetna last week, Aetna will make no exceptions to their rules of in- and out-of-network, even if there is no in-network facility in the area, or the only one they have is full and will accept no new patients. That means that this retiree had already paid his $500 deductible and out-of-pocket $1,500 expense and THEN had to pay an additional $1,000 deductible for out-of-network, and THEN pay 50% of the remainder of the bill for a 10 day stay!
If this retiree had been with Medical Mutual, he would have had no second deductible to pay and would have paid 20% of the remainder instead of 50%. This is another interesting fact: if this retiree had had Medicare A instead of of STRS Aetna, he would have paid ZERO ( 0 ) for the nursing home care.
How is that for equivalent? But Mr. Russell at STRS says that STRS covers their over 65-year-old retirees with equivalent coverage to Medicare A. Look over the information carefully -- call both Aetna and Medical Mutual for a provider handbook for your area.
Aetna's book of providers is not nearly as complete as that of Medical Mutual. Aetna does not even list nursing homes and some other specialities. So the ill member or a stressed spouse must have the presence of mind to call Aetna to see if providers that may be needed immediately are in the network.
Ask questions of Aetna, Medical Mutual and STRS and then decide what is best for you.
-- Shirlee Zerkel
10/11/2005
Thank you, Shirlee, for a real eye opener! KBB
Molly Janczyk adds:
I do know that in Cols. many Dr.s refuse Aetna due to non payment or slow payment. I also suggest Med Mutual but as Shirlee says: Be sure to ck in advance if your caregivers and facilities are IN NETWORK and that you are precertified BEFORE admissions. She is correct: Med Mut has only SOME facilites in network in each area. In cols. there are several for each end of town vs. the one for Aetna in an area Shirlee mentions. IF you go to ones out of network, you will pay addt'l deduc. and add'tl out of pockets. ALWAYS CK FIRST! Folks get confused because Medicare alone allows any facility; STRS insurance providers allow certain ones. You can get a list of the ones near you by calling. Also the facility will call and find out for you as well. If out of network it is an add'tl $1000-1500 you must pay. What STRS means is: comparable coverage for IN NETWORK! Medicare has no certain network facilities. With STRS we do have to ck up front for precerts and network.
posted by Kathie Bracy at 11:15 AM
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