Public shaming works – but it's also a sign of how broken the appeals process is in the US health insurance industry
In December 2016, I was hospitalized with severe electrolyte abnormalities that were causing fatigue, muscle cramps and chest discomfort. I received care at my local hospital, which was nationally ranked both overall and in the treatment of endocrine conditions, and I recovered fully. A month later, my heart sank as I received a letter from Aetna informing me that the hospitalization, amounting to nearly $30,000 in treatment, had been deemed not medically necessary. Coverage was denied. The case had seemed crystal clear. My calcium level was below the critical value of 6.0. My magnesium and potassium levels were likewise below normal. I was experiencing chest discomfort and pain and was at risk of cardiac arrhythmia. What's more, I was struggling to keep oral medications down, making it even more difficult to recalibrate my electrolyte levels at home. My admission was a slam dunk, endorsed by both the emergency medicine and endocrine physicians. But in the insurer's eyes, the treatment was not necessary. I was livid. I was a new political science professor, and busy juggling new courses. In between classes, I called Aetna to try to resolve the matter, but the long wait times were exasperating. Instead, I tweeted my frustrations about the denial and tagged the company. I did not know if they would respond, but I wanted whoever monitored the account to be made aware. Perhaps equally importantly, I wanted to get this exasperation off my chest. To my surprise, Aetna replied, inviting me to connect with them. When I did so, they provided a social media-specific email I could contact. I explained my medical issue very plainly over email, saying that I had needed multiple days of intravenous calcium replenishment and fluids and cardiac monitoring before I could be safely discharged. Soon, an Aetna staffer informed me by phone that they could not see why the claim was denied and that it may have been an error. The denial was reversed before I ever saw a hospital…