Shirlee to Sandy: Questions about preventive services in Basic Plan for 2007

Shirlee Zerkel to Sandra Knoesel, December 11, 2006

Dear Ms. Knoesel:

Some preventive tests and services that STRS says are covered, are not on the printed list from Medical Mutual. What is going on here? About a month ago I spoke with Medical Mutual and was told that only one routine visit a year was allowed; now I am told that I can go to a GP for a routine physical and then also to a GYN for a female exam and both would be covered by the 100%. Today, I spoke with Medical Mutual about the differences in the lists and was told that STRS was to get information out to the members on the basic policy that could be taken to our doctors so they would know what is covered as routine.

I was also told today by Medical Mutual that the colonoscopy is routine until they find polyps that have to be removed during the procedure. Then it becomes a medical situation, subject to the deductible in our insurance policy. Yet the retiree does not know which it will be until the test is over. Will it be no cost or will the retiree have to pay for the entire test? That is a very expensive test and the retiree's budget may not allow for such an expense. Is this a way to keep us from using the 100% routine preventive services. Is this same feature also true for other preventive tests -- that if an illness is uncovered by the test, then the test will not be covered 100% because it is now a health condition?

Please clear this problem up for us on the basic policy. The two lists from STRS 9 website and printed pamphlet) and Medical Mutual information sent to me by MM do not agree in the eyes of this retiree. Sandy, you stated in an email to me that you were working closely with Aetna and MM concerning the coverage. I do not see that STRS and the insurance company are on the same page. We, as retirees, sure do not know at this point just what we are entitled to concerning health preventive tests and services. I am not the only confused retiree, and the person at MM also has received many calls with these same questions. This information should have been clearly spelled out before the open period of enrollment for 2007!

Sincerely,

Shirlee Zerkel