Standards of evaluation in speech-language pathology

Standards of Evaluation

Module 2- Standards of Evaluation

The overall care offered under my current Aenta health insurance plan appears to be excellent with regards to freedom of care and flexibility. The plan is a group plan meaning that it is though an employer and therefor the rates and copay is lower and subsidized by the employer. As with any plan, there are pros and cons regarding the overall coverage.

With regard to access, my Aetna plan is by far superior to other plans. My plan is a PPO. This means that I never have to ask for approval before seeing any physician or seeking treatment. Whereas with HMO plans, participants have an assigned primary care physician and they must seek approval in advance before seeing any specialists. So, my choices are unlimited with regard to physicians.

The only area where access is in question is regarding alternative healthcare services such as chiropractic and massage therapy. These services are not at all covered by the insurance. This means that should I choose to see a chiropractor regularly, it is an out-of-pocket expense. The only way that Aetna seeks to reduce the expenses for customers is by offering a contractual discount of 25% per visit for participating natural providers. So for those who prefer using only mainstream medicine, Aenta is a good choice, but for those who prefer more natural methods, it greatly limits the options.

With regard to quality, there are some issues regarding long-term treatments. Aetna follows standard guidelines for routine hospital stays, such as 48 hours after a natural delivery of a baby. Aetna differs, however, with regard to long-term and terminal care of patients. For example, physicians must seek approval before requiring in-home care of a house bound patient. Additionally, Aetna requires approval for entrance into Hospice and other terminal care programs. This could potentially result in greater pain and discomfort for terminal patients, which is certainly sub-quality care.

Third, as with any plan within the United States, health insurance is expensive. However, since this a group plan it is much less than similar private plans. For example, the co-pay under the Aetna plan is $20 for in-network providers. Under Blue Cross, a competitor, the copay is $30. Additionally, the yearly deductible is $500 under the Aetna plan which is the same under the Blue Cross plan. So, overall Aetna is a less expensive plan than its competitors for those requiring regular physician visits.

Finally, Aetna's continuity of care is at the same level as other competitors. With both Aetna and Blue Cross, followup visits are always covered as are hospital readmission. Additionally, yearly health exams are completely covered.