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.]