Aetna Rejects Teen for Health Coverage Because of Acne

I recently wrote about Steve Case's desire to change health care through his new company, Revolution. All of the sudden, I'm on that boat, cheering for whatever it takes to bring down the current system.

My point of epiphany? Aetna just today essentially said it won't cover my daughter because she takes prescription drugs to help with acne.

The entire fiasco is more complicated than that, but once you boil it all down, that's the outcome. Aetna told me that if I want coverage, I'd have to tell this 17-year-old to go off the medication. Like I'm going to do that.

This episode also suggests what a technological backwater the health insurance companies must be operating in. Aetna's computer systems and software apparently aren't sophisticated enough to handle flexibility in pricing and analyzing applicants. Meds for acne are treated the same as meds for liver disease or anything else. An auto insurer like Geico looks at an applicant's driving record and adjusts pricing and makes an offer. Aetna looks at an applicant's health record and can pretty much just say yes or no.

Also baffling: I've been an Aetna health insurance customer, through Gannett, for 25 years. I now need to buy an individual policy, and wanted to get it from Aetna. You'd think Aetna's database could've spit out 25 years worth of information about me and my family and figured out coverage options that would keep me as a customer. Instead, I had to fill out endless medical forms like a brand new customer, and Aetna's evaluators apparently had no way to look back into my family's history with Aetna. How crazy is that?

No wonder the tech industry looks at the health industry and salivates. Through my tiny little window, I just got a glimpse of a massive, horribly-managed data problem that's badly in need of a solution.

. □