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Letters: Breaking down medical bills

June 05, 2012

Re "Dad calls foul over medical bill," Column, June 1

David Lazarus is to be commended for going toe to toe with health insurance behemoth Aetna.

Jim Furlan was stonewalled by an insurance company that refused to cover a necessary MRI because he had not gone through Aetna's "prior approval" process. At one point Aetna suggested that the physician who had requested the MRI without prior approval should pay for the test.

Lazarus got Aetna to do the right thing.

Prior approval, in theory, protects patients and insurance companies against unnecessary procedures. In practice it is actively used to place burdensome hurdles in order to improve the company's bottom line while delaying delivery of medically necessary care.

In 2011, Aetna's chief executive received

$9.7 million in pay, money derived from health insurance premiums. He didn't call Furlan to request prior approval.

Howard R. Krauss, MD

Los Angeles

Aetna is to be commended for doing the right thing for Furlan. I've been caught in the middle of billing mix-ups and know how maddening they are.

But how many different "schoolings" from how many different insurance companies with how many different variations on plans and coverage will each physician's staff need to have? Today we bill Anthem Blue Cross, Aetna, United Healthcare, Blue Shield and Plan XYZ. This plan covers this procedure but not that procedure. This company requires pre-certification; that one doesn't.

Yet another indication of how broken our healthcare system is.

Mary Edwards

Los Angeles

If Aetna had accepted the original bill and paid its "agreed" fee for the MRI, how much would the payment have been? I suspect it would have been a fraction of the nearly $6,000 billed to Furlan.

On a $140,000 hospital bill, my insurers ended up paying less than $20,000. Pity the poor person who has little or no insurance.

John Churchill



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