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Dangerous Precedent

Aetna did a very stupid thing. They allowed themselves to be bullied in to paying an extra-contractual claim after bowing to pressure from the Twitter-brain crowd.   

Arijit Guha, an Arizona State student bought a limited benefit student health insurance plan. Every one I have reviewed is terribly flawed and overpriced for the “benefit” you receive.

This one is no different.They even include a “disclaimer”

Your student health insurance coverage,offered by Aetna Student Health*, may notmeet the minimum standards required bythe health care reform law for therestrictions on annual dollar limits. Theannual dollar limits ensure that consumershave sufficient access to medical benefitsthroughout the annual term of the policy

The above language applies to the 2012 – 2013 policy year. We have no way of knowing if similar language was included in the one purchased by Guha. Currently receiving treatment for stage 4 colon cancer, Guha quickly exhausted his $300,000 lifetime limit on benefits under the Aetna student health insurance plan.

After multiple surgeries and costly chemotherapy sessions, the 31-year-old Phoenix man quickly surpassed the $300,000 lifetime limit on his Aetna student-health-insurance plan with another $118,000 in medical bills left unpaid.

 Facing the prospect of medical bankruptcy, Guha launched a website, Poop Strong, and sold T-shirts and trinkets to raise money to pay for his costly chemotherapy and other medical bills. He also has used Twitter to rail against what he considers the outsized profits of Aetna and the health-insurance industry. 

To his surprise, Aetna CEO Mark T. Bertolini engaged Guha via Twitter and addressed the student’s plight. The result? Aetna agreed to pay the student’s medical costs despite his policy’s maxed-out coverage.

While generous and noble, paying extra-contractual claims because of public pressure is foolhardy. Future policyholders can simply claim ignorance of the provisions in their policy and engage in social blackmail in hopes of getting the carrier to pay up.

Now comes a new school year and a chance (perhaps) to purchase a new Aetna plan. Even if he qualifies, most student health plans exclude pre-existing medical conditions.

Oh well. Perhaps Aetna’s CEO Bertolini will offer to cover those expenses as well. After all, he has set a precedent.

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