What a Recent Lawsuit Against Aetna Means for the Insurance Space

By: Dr. Bernie Saks
President and CEO at ful.

Ever wonder why people don’t trust health insurance companies?  It’s because the moment insurance companies receive their first premium payment, oftentimes, those premiums are used against the consumers. Too often, those payments, are used to cushion insurance companies’ profits.

We’ve all encountered someone close to us that’s had to jump through hoops to receive the healthcare or medications their doctor has prescribed. Unfortunately for many of those people, once they receive the care or medication they need, their insurance companies don’t cover their care or drugs. Instead, it becomes an OOP expense for them. So, all these hoops and obstacles projected before these members are hidden under the guise of helping the payor and the member. It begs the question should insurance companies act as fiduciaries while managing your health plan?  The answer is likely “yes” if they are managing a self-funded plan, and maybe not if they are providing traditional coverage.  The truth is that self-funded or traditional coverage insurance companies exist for profit.

A recent lawsuit filed by Kraft Heinz against Aetna has stirred up an important conversation about healthcare. How? Well, after Aetna failed to comply with Heinz’s request for their healthcare claim data, other employers felt compelled to investigate their own healthcare spending. Though Heinz hasn’t been able to prove that Aetna’s been misappropriating funds, by not sharing claims and payment data with their client, Aetna’s actions critically challenge the new wave of healthcare transparency. A consumer-driven product should manage your money, not take it, and healthcare consumers want to know where their money is going—they deserve to know where their money is going.

ful. was built to help payors and their members become savvy healthcare spenders, who engage in their healthcare choices, to help conserve their healthcare savings toward better financial outcomes. With ful., the responsibility to put member’s health and financial wellness above all else, is paramount. ful. helps self-funded plans perform better by providing a richer benefit for members. How? By boiling down 1 billion points of data and making it easily actionable for members, so they get quality care when they need it, with guidance that includes OOP costs, so they know what to expect when they see the provider.

Interested in learning more about ful.? Contact us today.