Aetna's CEO pays workers up to $500 to sleep | Hacker News Reader

Aetna's CEO pays workers up to $500 to sleep

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80 pointsdavidf1869 comments

I hate insurance companies. For one, they refused to pay for pre-approved claims when my wife had cancer and was being treated at Stanford (We were double-insured. Apparently, when you have two insurances, it is common for carriers to decline payments in the hope that the other insurance will pay it.) So my wife couldn't get out of bed and we literally had a stack of unpaid bills over a foot high and totaling over a half-million dollars.

Another reason to hate them is what I learned from consulting for insurance companies. I've been told first-hand stories by claims-adjusters about how the fax machine is intentionally put on the other side of their building and the CEO's assistant goes by and throws out all the papers. (The have the sense not to question why that is done.) And they discover that anyone paying too many legitimate claims gets fired. And their doctor's "reviews" only exist to look for people who might die and have the family resources to sue, and to decline legitimate claims so that enough people give up on their insurance claims. They cry when telling these stories.

Addendum: My wife lived - but the experience was more horrible than I have words to describe. And I'm fortunate that I could afford to hire a consultant to work with the insurance company billing. It took 2 years, but we got most of it paid. I eventually wrote a check for a few thousand dollars to try to undo the damage to my credit report. To this day, I'm not sure why I had to pay that money and why it took two years when I had "great" insurance through two companies.

That's what happens when you make a for-profit business out of people's health, hoping the clients either never make a claim or that you can loophole your way out of saving some zeroes in a spreadsheet. Unfortunately, those zeroes could be the difference between your spouse living or dying. The underlying problem is a flawed healthcare system, but with even socialist countries' citizens starting to have to buy insurance to get the care they need [0], I'm skeptical any easy or relatively short-term solution exists.

[0]http://reason.com/blog/2014/01/22/socialist-swedes-take-to-p...

Two years ago my wife and I were unable to get Aetna to pay for a home birth, even though we got it approved ahead of time. After months of futile phone calls where they basically kept me on hold for 30 minutes and then told me to fuck off, what finally got them to pay up was an angry tweet I wrote. I thought it was silly, but was advised to try it as a last resort by the midwife's billing assistant. Amazingly, they reached out and immediately paid for it in full when they saw the tweet.

I wonder how many people never try what I tried, and simply never get their claims paid after getting filtered out by their phone network. Horrible system.

Exactly. Make a public fuss. I had a non-medical situation in which raising a public fuss resolved the matter quite swiftly when I had no other leverage.

Another thing that works is finding the format for e-mail addresses at the company and then searching LinkedIn for employees. Then use the Reply All button after you CC the whole company. If they don't respond it means that they didn't get the e-mail. Keep trying.

Aetna's phone support is a joke. You call them up and ask them a question and they just answer randomly. I call ask a question, they tell me yes. I call again 5 minutes later and ask the same question and get no. Even simple straightforward stuff like "is this doctor in your network."

Currently in battle with Blue Cross Blue Shield. Complete garbage of the universe. Been through 2 rounds of appeals with people that tell me that I am right, but the guidelines say they can't help me. Guess time to fire up the angry tweets.

Medical insurance in the US doesn't make any sense. Insurance is supposed to be a hedge against a large risk, but in the US we use our medical insurance to pay for common visits and prescriptions. Everyone is so used to this model that it doesn't seem weird.

Imagine if you used your car insurance to pay for gas. That would be ludicrous. No other "insurance" is handled in this manner.

Car insurance is worse actually. In the US if you have an accident with bodily injury the settlement can go in the millions, but the legal limit for car insurance is as low as 20k. They do the opposite of what insurance should do, hedge against a small risk and leave you unprotected from big risks.

> They do the opposite of what insurance should do

There are a couple of points you seem to be missing:

- This insurance works precisely as you say it should, but on a lower scale. In exchange for a fee, it protects you, the holder, from losses too large to easily absorb. If those losses aren't too large for you to absorb, you can post a bond instead of having insurance.

- You don't have car insurance for your own benefit. You have it for everyone else's benefit (that's why you're required to have it). It doesn't matter if you get wiped out by the fines resulting from an accident because that's not why you have insurance. The point of your insurance is to make sure that the parties you injure can recover something. The legal limit is therefore set at an appropriate level for that goal. If you want insurance that protects you at a higher level than that, you can easily purchase some with a higher cap.

The point of insurance is to protect the person you hit by ensuring someone will pay their costs. If the legal minimum is far below the potential costs, then the insurance is failing at that purpose, because it doesn't matter how many millions you settle for, most people can't pay it to you and being owed by a deadbeat doesn't pay hospital bills.

Should the legal minimum be close to the highest potential cost? You can cause massive damage if you hit a luxury car, or are involved in a multi-vehicle accident. Should you be forced to carry insurance that would cover these scenarios? That would drive up the premium of the legally required insurance, and likely increase the number of uninsured motorists. Considering most accidents result in rather small payouts, there must be a cost-benefit analysis done to determine the legally required minimum.

I think a fair legal minimum is the average price of a new car.

The price of the totaled car is by far the smallest sum if you have really injured someone. In germany the default amount your are insured against is 50 or 100 mio €. 20k is a joke.

The property is a trivial cost in comparison to personal injury liability.

Yes, of course! I never claimed otherwise!

However, you need some number so I think that makes some sense as a starting point. 20k is the minimum here and that's low in my opinion.

Actually now that I think about it there bodily injury is separate from property injury. Here it's 20k property injury and 30k bodily injury are the legal minimums.

I just remember being surprised because cars are so expensive it is not hard to do 20k in property damage, just hit a late model car.

>there must be a cost-benefit analysis done to determine the legally required minimum

If you are saying that this is necessary, then I agree. If you are saying it is happening already, then I am skeptical and would like to see evidence.

20k? That is madness.

It's up to 100 Mio € over here in some european countries.

> Imagine if you used your car insurance to pay for gas. That would be ludicrous.

That's not ludicrous enough for me. Can the insurance be provided through my employer so that I'll need different insurance to pay for my gas if I switch jobs?

Only if gas stations can charge ludicrously higher rates to your provider but lower it to something reasonable for uninsured drivers.

No, that's backwards. The gas stations charge ludicrously higher rates to the uninsured drivers, but charge less than the wholesale price of gas to the providers. I think. I can't be sure because the price of gas isn't posted, and the gas station attendants don't even know the price. All you can do is pump it, then see what number pops up afterward.

And everyone thinks this is "normal".

That's the thing: medical insurance in the US is a weird hybrid between actual insurance and a complicated web of collective purchasing agreements. They let large organizations, companies and even individuals to get together by proxy to get bulk discounts on health costs.

You can see why this second function might be useful, although it also does weird things to the market. But it feels like it should be fundamentally distinct from insurance against risk. Having both functions in one line-item just makes everything more complex and confusing.

It also makes sense because medical insurance is a special channel for companies to give additional compensation to their workers. I've heard this originated from salary caps during WWII—turns out that if you try to ham-fistedly control the markets, you'll get weird ripple effects. If you're just channeling money to your employees, paying for their routine expenses makes sense especially since people can appreciate immediate benefits like that a lot more than the abstract benefit of having a low-probability risk hedged for you.

If you were actually going to design a system for managing health care from the ground up in the US, this is absolutely not what you would come up with. It's hideous legacy code. And it's just as hard to update as legacy systems, with the additional barrier of politics thrown in.

It doesn't really make sense, but you can sort of trace the reasons it evolved the way it did. And it's not changing significantly any time soon.

It's not apparent to me that my insurance company is engaged in attempting to get bulk discounts.

I have some recent bills that are 4x or 5x the supposed national rate for the services, having that hospital in their network appears to be a choice to try to collect premiums from people that live near it rather than the result of any sort of negotiation on my behalf.

I have the idea that we should ban networks. Not that we should ban insurance companies from trying to negotiate, but that we should prevent providers from charging arbitrarily different rates to different people. Especially hospitals that benefit from exclusive licenses, they should suffer under price regulation in exchange for those licenses (never mind that those licenses are intended to allow them to charge more for those services and "cost shift").

I don't think they actually write a check for the amount the hospital owes. I think my EOB for surgery looked something like:

Item: drugs Amount requested: $7000 Amount paid: $3 Amount owed by patient: $0

Do you mean the amount the hospital bills?

I'm talking about a bill I have to pay to meet my deductible, so the 5x number is the number that appears in the EOB (the covered amount for the service) and unless I am mistaken, it is the amount they would pay if I had met my deductible.

My paranoid speculation is that they push back harder against the coding of bills that they are responsible for than they do for bills that are under the deductible. This doesn't really make sense (the insurance company should want to control costs all the time), but it feels good.

I was well over my deductible by the point of surgery, so I don't know. I paid the hospital a total of 22 cents of my own money for an overnight stay. That was probably an oversight, but whatever, they can have 22 cents.

Anyway, like everything in life, the prices are negotiable. My insurance wouldn't cover the surgeon's time for the surgery despite pre-approving it, I negotiated quite a discount on that. (It was Aetna too. Good to know the claim was denied after a good night's sleep.)

And yes, I did typo/braino that. The hospital owes no money :)

I wish I could upvote this more than once. In my view, this is one of the fundamental problems with the healthcare system in the US. People may not love car insurance - but it's a far cry from the vitriol reserved for medical insurance. And I think this issue is the fundamental cause of that problem.

I want to be insured against rare, ultra high cost events that would otherwise wipe me out financially. I don't want to be insured against the price of my yearly checkup or an antibiotic prescription. I'm happy to pay for that out of pocket, and do my own price shopping for it.

And do you want to be insured against a chronic illness that will require regular not that expensive doctors visits like rheumatism or gout?

I mean, obviously it's a spectrum. I think for me personally i'd opt not to be insured for that. But I wouldn't say that someone who does is being unreasonable.

My point is just that with insurance companies being expected to should literally all medical costs, price signaling is taken out of the market, and that is a bad thing.

Google for State Farm customers with personal injury claims. Plenty of vitriol out there.

The vast majority go for regular visits, so the small copay makes it seem they are getting good value.

But regular visits for me were cheaper when I had no insurance and told the doc that up front. Now I pay $350/month so that I can pay more for my regular visits.

Health care works using a subscription model all over the world. You are simply confused by the word "insurance".

I'm sorry.

I think their are fixes, but the average American doesn't seem to want change.

All these big corporations need to do is throw some money at advertisers, create a little scare--almost always just a scare tactic. Like there will be Death Squads, or we will have to wait six months for a MRI, and the people just cave in, and say no to any changes.

Again, I'm sorry about your wife.

Oh yes, the "death panels" nonsense. I remember that bullshit. These insurance companies already are death panels, by design. They have a big pile of money and they get to keep every penny they don't spend on someone's healthcare. Of course they're a fucking death panel. Their business model is letting the most people die without it becoming so obvious that people stop giving them money.

There is now the 80/20 rule:

https://www.healthcare.gov/health-care-law-protections/rate-...

They have to spend 80% of premiums or give money back. This is supposedly a cost control, but it isn't clear to me that it provides the right incentives (the easiest way for an insurance company that hits the rule to increase their profits is to raise premiums...).

Having worked for Fortune 50's for most of my life, I'm not optimistic about that law. There are so many ways to adjust accounting that it is just amazing. And every company uses many offshores these days - they provide services and costs to get profits offshore. And they provide "services" that can be classified in any way they want. Really, that law sounds like just another deception for the masses who don't really understand how the system works for the rich.

On a related tangent, I am reminded that the extraordinarily successful Harry Potter series of movies made a loss on paper. As you suggest, these people laugh in the face of the law.

Medical insurance in the US is absurdly corrupt. Fun fact, health insurance companies are exempt from most anti-trust laws. Health insurance companies are free to collude on price and split up states between each other to limit competition.

> Health insurance companies are free to [...] split up states between each other to limit competition.

Aren't health insurance companies legally prohibited from operating in more than a single state?

I think they are just restricted to selling each policy in one state - but they can have 50 policies, one for each state.

The people who cry when telling work stories from insurance companies should seriously quit and preferably go to the media about why. I really don't doubt that if they asked for $1 on the media they'd get much more than their salary back for exposing this nonsense.

The insurance companies are careful not to do anything illegal. Declined reviews and firing people and "losing" paperwork can all be explained away. I spoke to an attorney after doing work for a couple of insurance companies -- and asked how they could get away with the things they were doing. He explained to me that their endless review process is really a way to stay out of court almost indefinitely. Apparently, there is some legal concept that if 2 parties are still in the process of working out a resolution (there are more reviews which can be done), then the case will be thrown out until the process is completed. So those reviews are really there to prevent you from ever getting a claim resolved. This is all legal (and I would argue created by our government which has been purchased by lobbyists.) So some low-paid claims adjusters losing their job for no reason really makes no sense. The corrupt insurance industry has been reported-on in books, movies, and articles for my entire life.

Seems like a PR move more than anything else. I'm tired of hearing about all of these weird benefits. How about just an awesome place to work that pays well?

Weird benefits are a result of employers trying to incentivize their workers to behave in certain ways.

For example, the weird benefit that many US companies give their employees reduced healthcare premiums if they certify that they are tobacco-free

If it's a PR move then they think the public they're relating to is dumb as hell because they're giving $500 to their employees instead of paying out the legitimate claims they're supposed to, causing doctors to drop them en masse while the customers left stuck with them have no place to get proper medical service.

It does pay well. :)

This seems like a creepy overreach into personal matters that's bound to continue, and likely end badly.

I'm curious how you see a voluntary program to pay employees to do something they should be doing anyway is creepy and/or overreach?

Voluntary work from home policy (required for work from home): We can visit and photograph your desk at home any time we want.

I have seen contracts like this and it's becoming more and more popular.

Where?

Citation needed

The program being voluntary does not make it un-creepy to use devices which track what an employee is doing at home.

Many people use non-free software and devices which can (and often do) spy on them. It's voluntary, but the spying is still creepy.

I understand that it's voluntary, but the company has literally followed its employee into the bedroom, via remote sensor.

It's easy to see how that might be unsettling to some, even to suggest, "hey, wear this leash on your off hours, and I'll give you extra money."

That's hyperbolic, don't you think? Is there anything in this policy that says you have to wear it anytime other than when you're actually sleeping? Put it on when you're ready to actually sleep, take it off when the alarm goes off. Rinse and repeat.

Economically, it isn't purely voluntary. Aetna will factor the cost of this program into their hiring decisions, so you're working for less than market rate if you do not let Aetna track your sleeping patterns.

> Aetna will factor the cost of this program into their hiring decisions, so you're working for less than market rate if you do not let Aetna track your sleeping patterns.

That's a bit of a stretch

I wouldn't wear a fitbit for $500 a year.

Attach it to your neighbours dog. Instant profit!

Mark seemed to have the conversation under control with all questions being fired off.

From the ~500 datapoints i have regarding my sleep from sleepcycle I would also say that sleep plays a large factor in how I can perform in my school tasks. Now at around 7 hours of sleep, Ill land to a "~70% sleep quality". At that point, I am able to perform the task in class, with little feelings of distractions, drowsiness. etc.

Do you have to get all 20 days of 7+ hours of sleep in a row with no screw-ups? If so, seems rather unlikely to happen!

Well, you have a whole year to get a consecutive 20 days. I think the goal is to build a habit.

The article is poorly phrased -- I believe the "in a row" applies to (7+ hours of sleep) instead of (20 days of 7+ hours of sleep).

In other words, just the seven hours of sleep has to be contiguous?

"In a row" wouldn't normally be used with units of time like that, it implies something happening each time (in this case the 7+ hours of sleep, happening each night)

Bertolini is quoted as saying "up $500 a year". Assuming he meant "up to $500 a year", a run of fewer than twenty days would lead to a reward. Presumably only the longest run of the year counts.

... especially if you have family members (like small kids) that can wake you up, and you have no control over that.

Don't most people sleep at least 7 hours continuously almost every night?

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