Aetna terminated my health insurance... what can I do?

I’m still shocked by this, but Aetna has terminated my health insurance for no reason - I’ve made all my premium payments timely. Aetna concedes this fact. I received no notice that the policy would be terminated. Aetna tells me there was no reason my health insurance should have been terminated, but they won’t re-instate it. At most they just sheepishly tell me “we’re working on it” and nothing ever gets fixed. Sometimes they say they’ll call me back in 24 hours to let me know the status - nobody has ever called me back. I can tell from the service reps’ voice that they know they’re lying to me, and they know this was intentional and that it’s never going to be re-instated. One lady sounded like she was about to cry. This is intentional - policies don’t get cancelled by mistake.

I’m one of those people who couldn’t get a health insurance policy prior to the Affordable Care Act because of pre-existing conditions (nothing too serious, not cancer or aids or anything like that). I’m pretty it costs them more to pay for my medication etc (even though they’ve refused to pay for pretty much everything) than I pay for my monthly premium. The whole point of the ACA was to force everyone to buy insurance to spread around the risk/cost amongst everyone. But they still see policies like mine as a loss. Now it seems they’ve found a loophole - just terminate the policy without cause and keep the premium payments. Take my money and give me nothing in return - blatant theft.

It’s criminal, it’s healthcare fraud, it’s breach of contract, it violates state and federal law. But that being said, as far as I can tell I really don’t have any meaningful remedy. I’m not going to be able to find a lawyer to take the case on a contingent basis - at most I can prove less than $3k in actual damages. To pay a lawyer hourly would cost more than I’d ever hope to recover in court. You can’t count on getting punitive damages. And Aetna knows this - which is why they’re doing it.

I can’t be the only one they’ve done this to - has anyone else experienced this or heard of them doing this to someone else? It sure looks like they can get out of paying for people with pre-existing conditions by simply terminating our policy, leaving us with no coverage, and just saying “fuck you” when we call them to demand that they fix it.

The really sad thing is that if I sign up with some other health insurance company for a new policy for 2015, Aetna wins - they get exactly what they want - they got rid of me. And it looks like they’re also going to get away with stealing nearly $1000 in premium payments I’ve made (timely, which they had no problem taking).

I have to assume all the health insurance companies have figured this out and are just terminating expensive (from their POV) policies left and right. Again, no justification exists or is given for why the policy has been terminated - they concede it should not have been. Unless the government is going to do something - and I know they won’t - it sure looks like I am left with no meaningful recourse. The only thing I can think of is to somehow get the media involved, but this doesn’t involve a Kardashian so I’m not even going to waste my time.

After this experience, it seems delusional for me to expect another health insurance company will take $300 in monthly premiums and pay $600+ per month for medication etc. They’ll just do the same thing and wrongfully terminate my policy after a few months. Why shouldn’t they? It’s good business as long as they can get away with it. And it sure looks like they can. Am I better off just paying the “no health insurance tax”?

Have you looked into seeing if your State Board of Health(or equivalent) can assist?

Just passing along information.

Seconded on the State Board or equivalent. Unfortunately the level of regulation and help will vary from state to state, but it’s a start. If for example you live in California, the Department of Managed Health Care or the California Department of Insurance will help you resolve this.

You can also try your state representative if you have a strong state government, your federal rep, or one of your Senators. You may get more response if the representative is someone who favors the ACA in the first place…

But the OP apparently got his Aetna policy after the advent of the Affordable Care Act

Legal advice is best suited to IMHO.

Colibri
General Questions Moderator

I would contact your Senator and the State Board of Insurance.

Ah. I didn’t check the date of the article.

I did file a complaint with the state board of insurance. But I live in Texas. A red state. Rick Perry. I don’t see anything being done against a health insurance company. That would be communist-socialist-muslim-black-skinned pro-obama liberal anti-christian, anti-white and anti-american.

I know the OP mentioned a lawsuit, but this really falls under consumer advocacy rather than legal advice. In fact the OP excludes a legal remedy as not affordable.

kaltkalt, even if your federal rep is not a Dem, you may be able to get a Dem rep who is not your own. If you are African American the staff of one of the AA reps may help you, similarly if you are Latino one of the Dem Latino reps may help.

Just because your state’s politics is dominated by such people, it does not necessarily follow that the whole of the state’s bureaucracy, especially that part charged with the duty of regulating the insurers, is.

The governor appoints all the heads of all these agencies. The low level people may not be partisan hacks, but the higher-ups who decide whether or not to take action against someone most certainly are. They’re all going to be evangelical right-wing theocratic “pro-business” Republicans who will see this as Aetna owing a fiduciary duty to its shareholders to wrongfully and unlawfully terminate any health insurance policy that’s not making it a profit. As long as people like myself have no meaningful legal recourse that could cost the company more money than it will earn and save by stealing my money, terminating my policy, and telling me to fuck off… then the company is doing the right thing for its shareholders. That’s the red state way.

I doubt any human being will even read the complaint I filed with the texas insurance commission or whatever it’s called.

Try your damnedest to get the media involved.

Well, it’s time to renew, I think you’re taking it too personally. I’m in Texas and have heard of companies pushing back against covered costs, I also have friends who enjoy all sorts of health problems and are sucking their insurance companies dry and getting no complaint. Shop for a new policy on Esurance, they have ACA eligible policies, really pay attention to the RX coverage you’re buying. No telling what’s going to happen with ACA next year, looks pretty certain the Republicans are dead set on screwing anybody lower income with pre-existing, that’s me too, luckily I don’t ever go to Dr. The Dems had a chance to reform health care but tried to reform insurance instead, whata bunch of bullshit, Gov. Strangelove had best get to work building a lot of new charity wards, looks like that’s where we’re all headed.

With all due respect I get the feeling there’s probably big chunks of this story being left out. Every time I see hear of these implausibly outrageous “It just happened and NO one will tell me anything” stories in real life that utterly defy common sense, in digging into the story it turns out the oppressed party is leaving out some huge chunk of the narrative. Maybe this scenario is different and Aetna really is an evil empire bent on cheating and crushing the OP but I wouldn’t bet the rent on it.

This is who you need to talk to. Get all your stuff together and send her an email explaining what happened. Send her copies of the letters that they sent you saying ‘we’re letting you go just because’.
Or, say stuff like this:

and just don’t even try. I mean, you can just not try and not get back on the insurance or you can try and at worst, not get back on or at best, get back on.