Healthcare reform is giving the consumer some say in their healthcare. It is why it had to happen. Up till now, the insurance companies have held the consumer hostage. They determined who would be covered, what services you were entitled to, how much you had to pay and at what the top amount allowed. As consumers, we had come to accept the parameters with little hope of change.
I have read the healthcare reform bill. I like many aspects of it but not all. What is hardest for me is the timelines of implementation. For instance, elimination of pre existing conditions from all plans start in 2014. Many of my clients who don’t have employer plans, are still facing life without insurance. The new high risk pools mandate six months without insurance. This means people coming off COBRA will have to wait six months. This is hard for someone with cancer. The older state high risk pools are so costly and many have long waiting lists. My clients are still be refused insurance for the simplest of problems. Anything in the past, whether cured and not reoccurring, causes a denial.
A friend of mine, has a strong family history of colon cancer. Fifteen years ago, he had a polyp. With regular preventive colonoscopies, he remains healthy. When he enrolled in a new plan, Anthem Blue, he was told the colonoscopy would no longer be covered because he had a preexisting condition. What part of prevention did they not get? Would it be more cost effective for the insurance to forgo the $3-4,000 cost every three years and pay for colon cancer treatment? Ummm, let me think… Luckily, under the new preventive care guidelines, it looks like he will be covered. I don’t imagine it will be simple for them to agree, but having an advocate on board will make it easier.
I am glad consumers are going to get an opportunity in every state to have external appeals and insurance companies have to tell customers of that option. Only 34 states have external appeals currently. The amount of external appeals are small considering it is an appeals process from an independent source. Some states, like California and New York, offer statistics on their insurance sites on the number of external appeals and results. What is interesting about external appeals determinations is it can approve/deny either part or all of the request. This appeals process is very important to consumers and will now be part of the healthcare/insurance landscape.
Living in Massachusetts, I know first hand the stress on the medical system with mandated insurance. It has not decreased ER visits which I think is the result of limited primary care practices and visit availability of medical professionals. The state government is constantly fighting with the insurance companies (great for bloggers) and insurance companies are tightening what is covered. I know people are happy to have coverage but for those outside the poverty level, it is still very expensive. I have to say life with mandated insurance, is both positive and negative. I wait to see how the rest of the country implements the changes.
