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Post by twoboyzmom on Feb 17, 2017 15:39:52 GMT
I swear if things don't change with healthcare!!! My husband is self employed so we get screwed on decent coverage. Had to get our of marketplace/Obama care as it more than tripled Found a plan thru US health group...but things keep coming up that I wasn't informed of by the agent... Like he isn't covered at his orthopedic Office, and is in severe pain, needs injection and mri and they won't even cover the visits! I know I'm leaving info out, but I am so angry, and feel awful for him...and wish I could just cancel this stupid plan, but their is nothing else! Sorry, just needed to vent
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Post by lbp on Feb 17, 2017 15:47:11 GMT
UGH! I hear you! My insurance has tripled in 1 year and we have a 4500.00 deductible! Every doctors visit is $45.00 and every specialist is $100.00. Needless to say, we have had to cut a lot of "wants" out of our life to be able to afford this. Something HAS to be done!
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Post by twoboyzmom on Feb 17, 2017 15:54:25 GMT
UGH! I hear you! My insurance has tripled in 1 year and we have a 4500.00 deductible! Every doctors visit is $45.00 and every specialist is $100.00. Needless to say, we have had to cut a lot of "wants" out of our life to be able to afford this. Something HAS to be done! We don't have a deductible, but high premium...but what is the point of paying for a plan that won't cover anything??? We can't afford the visits, injections he needs, the mri...I have multiple messages out to the plan, etc...but don't think it will matter...just so damn angry
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Post by annabella on Feb 17, 2017 15:59:14 GMT
I'm sorry you're going through this. Is there anyway to appeal? I don't think it's Obamacare's fault, I think Obama wanted to give everyone insurance coverage as every other first world country does. But since insurance companies are private, they had to find a way to continue to make outrageous profits so they screwed over their customers.
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Post by genny on Feb 17, 2017 16:06:51 GMT
We are in the same boat - self employed and had to go through the exchange. I did get a decent plan this year though (even though we had to pick all new drs!)…we were uninsured last year and wouldn't you know, we had several situations that ended up being $2-5000 each. I am paying on them all and it's frustrating knowing that I will be penalized this year when I do my taxes for NOT having insurance last year even though by the end of the year I'd probably paid $7000 in medical bills. I don't think I should be penalized on top of that since I've been paying as much as I can, even paying a few off. It's not like I just ignore them and don't pay them. We are having to cut back to be able to afford the new insurance AND continue to pay on last year's medical expenses. And there as soooo many entities to pay for ONE incident that it's extremely difficult to keep up with!
It's really disheartening. I agree something needs to be done. I don't know that totally repealing ACA is the answer though…if I had to pay the fully billed amount for my insurance I couldn't afford to keep it without subsidies. But the insurance we had before ACA was reasonable and worked well for us…it just wasn't ACA compliant once that got started.
I don't know what the answer is…but there has to be one.
I feel your pain...
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Post by twoboyzmom on Feb 17, 2017 16:07:43 GMT
I'm waiting for them to get back to me with a stupid apology then will see what I have to do to get this paid for..it's unacceptable
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Post by mikklynn on Feb 17, 2017 16:09:14 GMT
This is exactly why I am afraid to retire. DH's medical expenses were over $900,000 last year. I have to keep my employer's insurance.
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Post by ntsf on Feb 17, 2017 16:09:55 GMT
there is a solution.. medicare for all.. but politically will not happen.. medicare has low admin costs.. and we could put our energy into stopping fraud and raising reinbursement rates.
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Post by twoboyzmom on Feb 17, 2017 16:11:36 GMT
I am fortunate to have coverage thru my employer. Adding my DH to it would wipe out my paycheck almost completely...
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pudgygroundhog
Pearl Clutcher
Posts: 4,643
Location: The Grand Canyon
Jun 25, 2014 20:18:39 GMT
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Post by pudgygroundhog on Feb 17, 2017 16:16:16 GMT
We are in the same boat - self employed and had to go through the exchange. I did get a decent plan this year though (even though we had to pick all new drs!)…we were uninsured last year and wouldn't you know, we had several situations that ended up being $2-5000 each. I am paying on them all and it's frustrating knowing that I will be penalized this year when I do my taxes for NOT having insurance last year even though by the end of the year I'd probably paid $7000 in medical bills. I don't think I should be penalized on top of that since I've been paying as much as I can, even paying a few off. It's not like I just ignore them and don't pay them. We are having to cut back to be able to afford the new insurance AND continue to pay on last year's medical expenses. And there as soooo many entities to pay for ONE incident that it's extremely difficult to keep up with! It's really disheartening. I agree something needs to be done. I don't know that totally repealing ACA is the answer though…if I had to pay the fully billed amount for my insurance I couldn't afford to keep it without subsidies. But the insurance we had before ACA was reasonable and worked well for us…it just wasn't ACA compliant once that got started. I don't know what the answer is…but there has to be one. I feel your pain... There is an outline of what they want to replace it with, although it's missing a lot of details. From what I understand, subsidies will be eliminated and people will get age based tax credits and they also plan to rely heavily on HSA plans: ACA Replacement
Sorry you've been struggling.
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pudgygroundhog
Pearl Clutcher
Posts: 4,643
Location: The Grand Canyon
Jun 25, 2014 20:18:39 GMT
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Post by pudgygroundhog on Feb 17, 2017 16:17:51 GMT
I swear if things don't change with healthcare!!! My husband is self employed so we get screwed on decent coverage. Had to get our of marketplace/Obama care as it more than tripled Found a plan thru US health group...but things keep coming up that I wasn't informed of by the agent... Like he isn't covered at his orthopedic Office, and is in severe pain, needs injection and mri and they won't even cover the visits! I know I'm leaving info out, but I am so angry, and feel awful for him...and wish I could just cancel this stupid plan, but their is nothing else! Sorry, just needed to vent What is their reason for denying the visits? Usually visits like that are covered, but just billed at a high rate (either higher copay or coinsurance). Keep pressing - I think they just assume people will roll over. I hope you get resolution and sorry your husband is in pain.
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Post by twoboyzmom on Feb 17, 2017 16:19:15 GMT
I swear if things don't change with healthcare!!! My husband is self employed so we get screwed on decent coverage. Had to get our of marketplace/Obama care as it more than tripled Found a plan thru US health group...but things keep coming up that I wasn't informed of by the agent... Like he isn't covered at his orthopedic Office, and is in severe pain, needs injection and mri and they won't even cover the visits! I know I'm leaving info out, but I am so angry, and feel awful for him...and wish I could just cancel this stupid plan, but their is nothing else! Sorry, just needed to vent What is their reason for denying the visits? Usually visits like that are covered, but just billed at a high rate (either higher copay or coinsurance). Keep pressing - I think they just assume people will roll over. I hope you get resolution and sorry your husband is in pain. Something about pre existing...but he hurt his back and went to the orthopedic, which his primary told him to do..and they won't cover the visits.
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pudgygroundhog
Pearl Clutcher
Posts: 4,643
Location: The Grand Canyon
Jun 25, 2014 20:18:39 GMT
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Post by pudgygroundhog on Feb 17, 2017 16:22:20 GMT
What is their reason for denying the visits? Usually visits like that are covered, but just billed at a high rate (either higher copay or coinsurance). Keep pressing - I think they just assume people will roll over. I hope you get resolution and sorry your husband is in pain. Something about pre existing...but he hurt his back and went to the orthopedic, which his primary told him to do..and they won't cover the visits. How can they deny for pre-existing condition? Sounds ridiculous. I hope you get it sorted out.
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Post by iamkristinl16 on Feb 17, 2017 16:37:22 GMT
I am fortunate to have coverage thru my employer. Adding my DH to it would wipe out my paycheck almost completely... But would that amount be more than what you are paying now to have the separate plan?
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Post by twoboyzmom on Feb 17, 2017 16:43:28 GMT
I am fortunate to have coverage thru my employer. Adding my DH to it would wipe out my paycheck almost completely... But would that amount be more than what you are paying now to have the separate plan? No but I can't afford to have my whole check taken
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Post by twoboyzmom on Feb 17, 2017 16:44:52 GMT
Something about pre existing...but he hurt his back and went to the orthopedic, which his primary told him to do..and they won't cover the visits. How can they deny for pre-existing condition? Sounds ridiculous. I hope you get it sorted out. I know, I thought the law was you couldn't deny for pre existing
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Post by iamkristinl16 on Feb 17, 2017 16:57:04 GMT
But would that amount be more than what you are paying now to have the separate plan? No but I can't afford to have my whole check taken That really doesn't make sense. You are actually paying more per month, but it just isn't coming directly out of your check so that makes it better? Isn't the money for the insurance essentially coming out of your/his paycheck anyway?
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Post by twoboyzmom on Feb 17, 2017 16:58:37 GMT
No but I can't afford to have my whole check taken That really doesn't make sense. You are actually paying more per month, but it just isn't coming out of your check so that makes it better? I'm not paying near now what it would cost to add him to my work policy...but if I were to pay for all the things they aren't covering, I'd be on the streets!
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Post by jumperhop on Feb 17, 2017 17:02:17 GMT
Ugh!! I feel your pain! I had to switch insurance in Jan. I had to cancel an apt with my neurosurgeon in Jan because the new insurance company didn't do my paperwork until Jan 25th. I spent the entire month of Jan calling twice a week begging them to do my paperwork. Once we finally got our insurance cards I couldn't see Neurosurgeon without a referral from a primary care Dr which I don't have. I called the Drs on the list from my insurance company and they aren't accepting patients and are on a 6 month wait. My father finally had to make some phone calls to get me in. All for the going rate of $700 a month. jen
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Post by mlynn on Feb 17, 2017 18:43:21 GMT
We are in the same boat - self employed and had to go through the exchange. I did get a decent plan this year though (even though we had to pick all new drs!)…we were uninsured last year and wouldn't you know, we had several situations that ended up being $2-5000 each. I am paying on them all and it's frustrating knowing that I will be penalized this year when I do my taxes for NOT having insurance last year even though by the end of the year I'd probably paid $7000 in medical bills. I don't think I should be penalized on top of that since I've been paying as much as I can, even paying a few off. It's not like I just ignore them and don't pay them. We are having to cut back to be able to afford the new insurance AND continue to pay on last year's medical expenses. And there as soooo many entities to pay for ONE incident that it's extremely difficult to keep up with! It's really disheartening. I agree something needs to be done. I don't know that totally repealing ACA is the answer though…if I had to pay the fully billed amount for my insurance I couldn't afford to keep it without subsidies. But the insurance we had before ACA was reasonable and worked well for us…it just wasn't ACA compliant once that got started. I don't know what the answer is…but there has to be one. I feel your pain... There is an outline of what they want to replace it with, although it's missing a lot of details. From what I understand, subsidies will be eliminated and people will get age based tax credits and they also plan to rely heavily on HSA plans: ACA Replacement
Sorry you've been struggling. The problem with tax credits is that you have to fork out the money up front. For many, that just won't be possible. And what good is using HSA plans if you have no excess income?
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pudgygroundhog
Pearl Clutcher
Posts: 4,643
Location: The Grand Canyon
Jun 25, 2014 20:18:39 GMT
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Post by pudgygroundhog on Feb 17, 2017 18:46:48 GMT
Ugh!! I feel your pain! I had to switch insurance in Jan. I had to cancel an apt with my neurosurgeon in Jan because the new insurance company didn't do my paperwork until Jan 25th. I spent the entire month of Jan calling twice a week begging them to do my paperwork. Once we finally got our insurance cards I couldn't see Neurosurgeon without a referral from a primary care Dr which I don't have. I called the Drs on the list from my insurance company and they aren't accepting patients and are on a 6 month wait. My father finally had to make some phone calls to get me in. All for the going rate of $700 a month. jen Wow - what a pain. My insurance plan some years ago required a referral from a PCP to see a specialist, which for me was ridiculous. It was wasted time (on my part and the PCP) and money to go to an office visit just to have the doctor say yes, you need a specialist. My plan now doesn't require a referral. And even if it did - I can't believe you had to wait that long for a PCP. Is it because the in network doctors on your insurance are severely limited? Seems so wrong to require PCP then not have enough PCP doctors.
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used2scrap
Drama Llama
Posts: 6,036
Jan 29, 2016 3:02:55 GMT
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Post by used2scrap on Feb 17, 2017 18:47:38 GMT
I'm sorry. Healthcare in this country is such a shame. We should be able to do so much better.
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pudgygroundhog
Pearl Clutcher
Posts: 4,643
Location: The Grand Canyon
Jun 25, 2014 20:18:39 GMT
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Post by pudgygroundhog on Feb 17, 2017 18:49:26 GMT
How can they deny for pre-existing condition? Sounds ridiculous. I hope you get it sorted out. I know, I thought the law was you couldn't deny for pre existing I thought the law applied to getting health insurance in the first place. I've never heard of an insurance company denying treatment once you have insurance due to pre-existing. I mean, doesn't that kind of negate all sorts of appointments? Like when my daughter broke her arm and we had follow up visits - they could've said "nope, pre-existing condition). Hopefully you can get some resolution.
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pudgygroundhog
Pearl Clutcher
Posts: 4,643
Location: The Grand Canyon
Jun 25, 2014 20:18:39 GMT
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Post by pudgygroundhog on Feb 17, 2017 18:54:43 GMT
There is an outline of what they want to replace it with, although it's missing a lot of details. From what I understand, subsidies will be eliminated and people will get age based tax credits and they also plan to rely heavily on HSA plans: ACA Replacement
Sorry you've been struggling. The problem with tax credits is that you have to fork out the money up front. For many, that just won't be possible. And what good is using HSA plans if you have no excess income? I agree. I've been on a HSA plan before (and my husband is currently on one) - I viewed the HSA as a way to get some extra tax benefits and a way to save and pay for some medical costs, but having nothing to do with coverage. I'm fortunate we are in a position to put extra money away, but it's not feasible for many people, especially if the deductibles (or even premiums) are high for these plans. People have also pushed the HSA plans as a way for people to have more skin in the game and better use their money, such as "comparison shopping" for services. But that is not possible with the lack of transparency from health care providers on the actual, real costs of services and treatment. And if you are in an ambulance on the way to the hospital, you aren't exactly making phone calls to see where you can save some money. And the tax credits being age based might make overall sense in theory, but can still leave many people vulnerable - particularly young people with health issues and can still leave poor people with an insurmountable gap between tax credit and what their plans cost.
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mlana
Pearl Clutcher
Posts: 2,523
Jun 27, 2014 19:58:15 GMT
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Post by mlana on Feb 17, 2017 20:21:33 GMT
We're self=employed and we went without insurance for a very long time. I found an agent who was able to walk us through getting affordable insurance for our company. She listed DH and I as separate employees of the company so we met the 2 person minimum required; this cost the same as listing one of us as employees and one as employee's spouse. She put the kids on individual policies so DH's pre-existing conditions wouldn't apply to them and their rates.
This worked for about 10 years, but the costs went up every year. In 2015 we were paying over $1500/month for just our insurance. When you add our costs plus DD insurance, our insurance cost more than our mortgage. DH had his stroke in early 2015 and I got a letter from KP stating that our insurance for 2016 for the 2 of us was going to be over $2500/month. This was more than I could pay. I contacted my accountant and he suggested I contact my original agent to see if we qualified for insurance thru ACA. He was pretty sure that not only would we qualify, but we would also receive a subsidy. Our agent found this to be true and she helped us select a plan with Kaiser that offered a subsidy and paid the deductible. This year's insurance is more expensive and has a deductible, but it's still a long ways off from being $2500/month.
I suggest that if you don't get any satisfactory answers from the agent you have, you look for another agent. My agent is a small business person and she was able to take that experience and figure out how to make it work for us in ways that would never have occurred to me. She is very much a think-outside-the-box person, but she knows the rules inside and out.
You didn't say how many people your DH employees. Does he run his insurance thru his business or does he have a stand alone policy? Did he have a policy in effect when he hurt his back? It's my understanding, as a complete layman, that if you have a policy in effect when the injury occurs and you later switch to a different insurance without a period where you're uninsured, then there is no pre-existing penalties. If, however, there is even one day where you have no insurance, then they can disqualify covering something as a pre-existing condition. As I understand it, insurance companies cannot refuse to insure you due to a pre-existing condition, but they can sure as hell charge you thru the nose for it.
If your DH is a solo employee, it may be worth it to hire someone or to reorganize the company so someone else is employed and he could get different insurance as a multi-employee employer. In our case, the company is a partnership, so I could be insured thru it even if I wasn't an active employee (which I am.) If he can get access to insurance that is equitable to yours, it may be worth your while to consider doing this. Perhaps your employer would be willing to pay you the cost of your insurance, if you elect to go on your DH's policy. I think reorganizing the company would also qualify as an event that would allow you to select a new insurance provider.
You have my deeps sympathy; negotiating insurance is definitely a nightmare.
Marcy
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Post by twoboyzmom on Feb 17, 2017 20:25:55 GMT
We're self=employed and we went without insurance for a very long time. I found an agent who was able to walk us through getting affordable insurance for our company. She listed DH and I as separate employees of the company so we met the 2 person minimum required; this cost the same as listing one of us as employees and one as employee's spouse. She put the kids on individual policies so DH's pre-existing conditions wouldn't apply to them and their rates. This worked for about 10 years, but the costs went up every year. In 2015 we were paying over $1500/month for just our insurance. When you add our costs plus DD insurance, our insurance cost more than our mortgage. DH had his stroke in early 2015 and I got a letter from KP stating that our insurance for 2016 for the 2 of us was going to be over $2500/month. This was more than I could pay. I contacted my accountant and he suggested I contact my original agent to see if we qualified for insurance thru ACA. He was pretty sure that not only would we qualify, but we would also receive a subsidy. Our agent found this to be true and she helped us select a plan with Kaiser that offered a subsidy and paid the deductible. This year's insurance is more expensive and has a deductible, but it's still a long ways off from being $2500/month. I suggest that if you don't get any satisfactory answers from the agent you have, you look for another agent. My agent is a small business person and she was able to take that experience and figure out how to make it work for us in ways that would never have occurred to me. She is very much a think-outside-the-box person, but she knows the rules inside and out. You didn't say how many people your DH employees. Does he run his insurance thru his business or does he have a stand alone policy? Did he have a policy in effect when he hurt his back? It's my understanding, as a complete layman, that if you have a policy in effect when the injury occurs and you later switch to a different insurance without a period where you're uninsured, then there is no pre-existing penalties. If, however, there is even one day where you have no insurance, then they can disqualify covering something as a pre-existing condition. As I understand it, insurance companies cannot refuse to insure you due to a pre-existing condition, but they can sure as hell charge you thru the nose for it. If your DH is a solo employee, it may be worth it to hire someone or to reorganize the company so someone else is employed and he could get different insurance as a multi-employee employer. In our case, the company is a partnership, so I could be insured thru it even if I wasn't an active employee (which I am.) If he can get access to insurance that is equitable to yours, it may be worth your while to consider doing this. Perhaps your employer would be willing to pay you the cost of your insurance, if you elect to go on your DH's policy. I think reorganizing the company would also qualify as an event that would allow you to select a new insurance provider. You have my deeps sympathy; negotiating insurance is definitely a nightmare. Marcy It's just him, subcontractor..no insured employees. So it's a single person policy. Back issues come and go for years...just so happened to have a flare up shortly after policy became effective
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mlana
Pearl Clutcher
Posts: 2,523
Jun 27, 2014 19:58:15 GMT
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Post by mlana on Feb 17, 2017 20:33:23 GMT
It's just him, subcontractor..no insured employees. So it's a single person policy. Back issues come and go for years...just so happened to have a flare up shortly after policy became effective I'd seriously look into the availability of a multi-person policy. For us, the question wasn't affordability, but availability. The only way we could get insured was thru a multi-employee policy. If we had been able to get insurance on just us as individuals, DH would have been looking at a rate that was actually higher than what it cost to insure both of us thru the our company. Just something to keep in mind. Marcy
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Post by twoboyzmom on Feb 17, 2017 20:34:44 GMT
I have great coverage thru work and I know I won't get that thru a personal policy, so don't want to lose my coverage but applying with him...and there isn't anyone else to cover
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Post by gale w on Feb 17, 2017 20:49:22 GMT
I feel your pain. Our premiums went from around $700 to $1100 and then to $1500. They were going to go up to $2200 so we had to switch plans and now we pay $1400. All with a 6K or more deductible until now, where we have a $5400 deductible and 40% copay and we can't have an HSA unless we want to pay $2000+. It's ridiculous.
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Deleted
Posts: 0
May 18, 2024 23:15:25 GMT
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Post by Deleted on Feb 17, 2017 21:05:28 GMT
Americans can't seem to get behind single-payer. So we have for-profit insurance companies, docs, hospitals and drug companies all taking a piece of the pie every time we get sick or hurt. Until we get serious about single-payer or about making healthcare a non-profit utility, we will continue to spend part of every healthcare dollar on profits, companies marketing against each other, paying multi-million dollar C-level salaries and generally enriching investors vs. putting that money into actual health delivery.
"On Thursday, Aetna reported $734 million in profit on $15.8 billion in revenue for the three months that ended Sept. 30. The nation’s third-largest health insurer by revenue handily beat Wall Street estimates for the quarter. Chief Financial Officer Shawn M. Guertin cited “solid performance” in the company’s core health insurance business that offset “pressure” from its business under the Affordable Care Act.
Aetna’s earnings report came a week after UnitedHealth reported a 12 percent jump in revenue to $46.3 billion for the three months that ended Sept. 30 compared with the same period the previous year. The company collected $36.1 billion in insurance premiums, a sum 11 percent higher than for the year-ago quarter, while profits increased 29 percent to $1.98 billion as the company signed up 955,000 more health insurance customers through its employer and individual plans. (Anthem, Cigna and Humana will report their latest quarterly earnings next week.)
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