To me, that seemed like a bad idea. “The HMO would limit your choice if something bad and unexpected happened,” I told Howard. “What if you got a brain tumor or some rare eye condition or something that we can’t predict?” I favored staying with the Aetna plan and paying the higher premium for the remainder of the year. He could switch to my cheaper plan during the next open enrollment, allowing him to keep access to out-of-network doctors.
Howard, though, wanted Aetna’s HMO. We could save money. And Aetna’s network contained all the best cardiac surgeons and hospitals, names we knew from earlier heart valve surgery. His Aetna experiences had all been easy and in-network — and therefore would have been equally easy in its HMO. Howard also reminded me of my time-consuming hassles with HIP.
We did more research, asking friends with serious eye, back and other medical problems to identify their preferred specialists and hospitals and then checking to see if they were in Aetna’s network.
With one exception, the Aetna HMO network had all the favorites. We decided that Howard would switch to Aetna’s HMO. Proud of our careful and time-consuming choice, I was sure that Aetna’s HMO made more sense than its deluxe plan.
Preparing for surgery
Two years later, in early 2006, the endocrinologist treating me for diabetes decided insulin wasn’t doing enough for me and prescribed two fairly new drugs.
HIP had a very long process for approving coverage of the second drug. I presumed that was because it was not effective for most diabetics and was quite expensive. The review was exhausting, taking hours of time from pharmacists, my doctor’s nurse and me. I paid out of pocket several times to get the drug.
After the insurer finally gave approval, my pharmacist told me that he’d have to get reapproval every month. I gave up.
Such reviews are an important way to keep costs down. But with HIP it was hard for me to reach people and figure out what should be done. By comparison my husband’s experiences with the approval process for Aetna’s HMO were easy. I vowed to switch at the next open enrollment period.
So when my endocrinologist said that I might have Cushing’s, I mentally had already made my insurance choice.
Cushing’s disease, which often causes obesity, diabetes, depression and a characteristic moon face, affects only 10 to 15 of every 1 million people. The disease grows very slowly; I probably had had it for 10 or 15 years.
It took a while for my endocrinologist to confirm the diagnosis, partly because I kept postponing the inconvenient and seemingly endless tests. And before that final diagnosis, open enrollment rolled round again. If Cushing’s were confirmed, I knew I’d need delicate surgery on my pituitary, which lies at the base of the cranium. Having an expert surgeon would be critical, and this would affect my insurance choice.