Senator Ask's Aetna Why Texas Man With Insurance Owes $200,000

New York Times July 2nd.
Late last week Senator Charles Grassley sent a letter to Aetna insurance to ask why a policy they sold a Texas man didn't cover his hospital expenses.

"The man, Lawrence Yurdin, age 64, was included in a front-page article in The New York Times on Tuesday about the many people whose insurance coverage does not protect them from financial ruin in the case of a medical crisis.

Although Mr. Yurdin and the hospital where he received heart treatments say they both understood that the Aetna policy covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the medical care he received. He and his wife, Claire, filed for personal bankruptcy in December.

Senator Grassley, the ranking Republican on the Senate Finance Committee, has also investigated some of the health plans that another insurer, the UnitedHealth Group, sold through AARP, the advocacy group for older people. Those plans, which also had sharp limits on coverage, are no longer being sold.

“I remain concerned about health insurance plans that may appear to offer more coverage than they do and the effect subsequent underinsurance may have on the health care system as a whole,” Mr. Grassley wrote to Aetna’s chief executive, Ronald A. Williams."

In an article in the NYT last Tuesday entitled "Insured, but Bankrupted by Health Crises" Reed Abelson describes the specifics of Mr.Yurdin's case:

"...One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital...
"..“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”
"...Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”

“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.

Mr. Yurdin learned the hard way.

At St. David’s Medical Center in Austin, where he went for two separate heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna. St. David’s estimated that his share of the payments would be only a few thousand dollars per procedure.

He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care — the expenses incurred in the operating room, for example, and the cost of any medication he received.

In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months — as long as he did not need an operation or any lab tests or drugs while he was there."