Posts Tagged ‘ACA’

Thanks Obama/democrats, for making all chronically ill people literally worthless and forcing these rules upon insurers. You are discriminating against all but the healthy – and wealthy.
Background: My husband and I are a middle-class couple, just recruited by AARP (so you know how old we are…). I have health insurance though my husband – he pays almost $10K a year for coverage – his employer, a public school in metrowest MA, has forced us into an insurance plan this year called a “Best Buy High Deductible HMO.” We have ZERO choice in coverage. We had a very poor HMO previously – but at least I could see a doctor and get tests or prescriptions or surgeries as needed. Those days are gone.
What I detail below is what “our government” has “mandated” for our health care – the words of Harvard Pilgrim Healthcare customer service, not mine – and what those of you haven’t been subjected to this type of discrimination yet could be in for:
I had a “yearly physical” Friday at a Beth Israel Deaconess Hospital primary care facility in Wayland MA. (NOT run by the insurance company – so don’t confuse things). This annual visit is supposed to be FREE to patients under the ACA…..lets see how that works in practice here in Massachusetts….My PCP wanted to order the usual “over 50” tests. Before I could see the doctor, I was asked to sign a form based on the guidelines of the Affordable Care Act basically warning me that certain examinations/tests/procedures “MAY” to be covered under insurance. I will gladly provide anyone with a copy of this if they’d like, if they think I am making this stuff up!! I assure you that I am not. Since my PCP had questions about what he could and could not order, he asked me to call Harvard Pilgrim Health Care insurance Here are a few gems that I discovered during my calls (yes, 2 calls – the first girl I talked to informed me that ” HPHC was not in the business of “physician education” and that I would find out what was covered when I received my bill for the visit and procedures. How nice):
Any “annual” or “wellness visit” MAY NOT be covered (i.e., by coverage I mean paid for) IF anything is discovered that is out of the norm. (So, simply by being in the office and having a genetic issue like EDS, I am already triggering NON-COVERAGE of this visit.) Therefore, any tests ordered during/as a result of this encounter MAY not be “covered.” Even the dreaded colonoscopy. Because I need one under anesthesia (due to a genetic abnormality in my colon – not my fault) if may NOT be covered if the referring doctor and the facility performing the test do not use the “correct” CPT codes. The insurance company is not allowed to give patients these codes, and suggested that someone in your office call HPHC Patient Services to get these specific codes. (I have friends that are doctors – they laugh at these requests made by patients – they bill however they’d like!)
So, I have NO way of knowing IF I’ll be charged until after the procedure is processed – and when I receive the bill! A list of limited lab tests provided to me by HPHC ARE covered under “preventative care physicals” – but, the caveat I brought up above takes these tests outside of the coverage umbrella. Let me reiterate and emphasize: Any abnormality found/discussed/noted during a “wellness visit” can/may automatically make the visit and any subsequent testing NOT be covered, and we would be forced to pay 100% of all costs out-of-pocket. Because some abnormalities were found in one of my breasts, my mammogram cost is now 100% out-of-pocket, as the finding of the lumps immediately causes it to be a “diagnostic” vs a “screening” procedure. I can’t mage how expensive this is going to be,,,facility expense, actual test costs, radiologist cost to read the tests….
So, if you think that this ACA was supposed to allow people to get care regardless of their pre-existing conditions – you are DEAD WRONG. Sure, a doctor will see you – but it will cost you! And, with all the limitations that are placed on doctors – they are no longer ALLOWED to order certain tests, or prescribe certain medications, as they had been doing, as they were taught…
(It seems something happened to trigger these new untra-restrictive practices effective Jan 1 2016. I won’t speculate here, but I have an idea based on my research…).
However, those that have MassHealth coverage do NOT have most of these restrictions places on their care!!!
(I can answer this “why” regarding doctor choice – MassHealth can choose ANY doc they want to see that accepts MassHealth, because words contained in the MA general laws that govern MassHealth  – no restrictions can be placed as to which doctor public assistance recipients can see because doing so VIOLATES THEIR “PATIENT RIGHTS!”
So, since no MA legislation protects those of us that work hard, pay taxes, and pay for our insurance coverage  – we have NO patient rights.)
Oh – and a MassHealth patient  – plenty of whom are not even living in the US legally – pay only $4 per visit to see ANY doctor!!! Me, I have to pay 250-$550 per doctor visit. Prescriptions cost them $1-$9.  Don’t get me started on MY costs for prescription medication. As a Massachusetts resident, I greatly miss the “Romneycare” we had before Obama ruined things. We had coverage for health care, and pre-existing conditions were not allowed to be a determining factor of whether or not we got that care. It worked wonderfully.
Remember all that frantic worry about “death panels” before the ACA was enacted?? The current government has effectively found a way to to glean those with chronic illness and genetic abnormalities out of the population through these regulations!!
They have built-in these regulations so that they can “legally” refuse to care for patients l
like me unless we are very wealthy and can pay for out of our pocket for any care.
No money=no care=early death=less people the government has to care for. 
[NOTE: I do feel badly that doctors have been forced into this corner by these insurance rules, as are unable to practice medicine as they had in the past. It really puts the doctors in a difficult position, burdening patients financially, and creating more stress for all parties involved.]
Let the flames begin.

This has been a banner year for my soapbox. I’m getting more and more used to spending time on it. Now, if only people would LISTEN….

Being “blessed” with a bucketload a unusual conditions, I’m not short on subject matter. But, It’s not the actual conditions I usually blather on about – its the medical professionals, and the damn governmental interference in our health care choices and well-being.
Having strange conditions require a patient like me to familiarize themselves with the research being done on the conditions from which we suffer. This does not take a lot of time, thanks to the miraculous invention called the Interweb…errr, Internet. Since everyone 10 years and older has a phone that can access this miracle information retrieval system, there is absolutely NO EXCUSE why anyone should be uneducated about their medical condition, and NO EXCUSE why any medical professional can’t do a simple search on Medscape, PubMed or even Wikipedia to try and help a patent like me. I can find a helpful article relevant to any of my strange disorders in less than 30 seconds. Tell me then, why can’t a doctor do the same thing? Do they think they know everything? Do they not trust the information in their own peer-reviewed journals on the web? And don’t DARE say they don’t have time. The time it takes for any of my docs to disagree with me about my symptoms (really?? I’m experiencing them – they actually think telling me I’m NOT helps me?) or give me the deer-in-the-headlights stare when I start speaking their (not-so-exclusive) language takes more time than running a quickie search. You have the technology – USE IT!

My other recurrent theme is government intervention in our healthcare. The feminists of decades ago said it best, “keeps your laws off my body!” That goes for all the sneaky stuff incorporated into the ACA (Obamacare) that some people blindly embrace as “a good thing.” Yes, there are good things in the ACA, but have YOU read the 2500 or so pages contained in this scary piece of legislation? I have. You would be horrified to learn what I know. Some of the mainstream medical blogs address these issues from a doc’s point of view, which make me happy, and to which I quickly and eagerly add my comments. One particular doc for that writes for HealthworksCollective is ballsy enough to remove ALL of my comments, while others have been gracious enough to welcome the viewpoints and opinions of “an educated patient.” We are the consumers of healthcare. Most of us pay thousands a year for our health insurance. We have the right to choose our diagnostics and out treatments. In no way, shape or form should a sitting president of this country tell us what tests we can or cannot have – or what treatments are appropriate for us. How DARE the government lump the citizens of this country into neat little categories, which conveniently leave out people like me with uncommon disorders and conditions. If you don’t believe me, then you might want to look back into my previous blogs and see what damage has already been done. Just a few examples: Mammograms are limited. Back pain has been relegated to neat little boxes that limit the diagnostics and treatment for anyone suffering from back pain. The “most common” health challenges US citizens are faced with are being examined by an agency called the IOM (Institute of Medicine) – and are telling doctors the THREE best treatments for these conditions. What if you or your loved one isn’t helped by these? Oh well, too bad. You may point to the sources of the recommendations and say, “these aren’t from the government.” Oh, but they are. The ACA has tasked several quasi- and non- governmental “health” agencies (the IOM is one of them) with studying “the most common conditions” and asked for “recommendations.” It is these very recommendations that insurance companies latch onto and use as the basis for denying any but the recommended treatments, regardless of their insured’s health status. It’s happened to me. It’s happened to friends of mine. Standards of care are being ignored and these recommendations are being embraced. For example: BCBS of MA recently denied MOHs surgery for suspected basilar cell carcinoma on my friend’s face. They claimed they “never heard of it!” She had to gather research and practice guidelines to submit to them to prove it was THE standard of care for the treatment of suspected basilar cell carcinoma, especially for facial lesions. I also gave her info that my father-in-law, covered by BCBS, had had MOHs at least 5 times just this year. (Somit was total BS that BCBS had “never heard of MOHs.” It was finally approved, and yes, she DID have cancer. NO PATIENT, especially one that has to pay thousands a year for health insurance, should be forced to do her own research like this – it’s ludicrous. But, we have the ACA to thank for these new glitches in our already confusing matrix. Naysayers say we have to take the bad with the good, referring to the ACA provisions. I say NO, WE DON’T.
Patients, educate yourselves on your conditions.
Doctors, pay attention to what your patients are saying. And while you are staring at them in disbelief, try doing a bit of research of your SmartPhone – what you learn may surprise you.
And Obama, keep your laws off my body.