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Thursday, March 25, 2010

And so it has passed...

Many acquaintances and coworkers have asked my opinion of the Healthcare Reform Bill, mostly because of my position as a Patient Account Representative at our local clinic.  To be honest, while I followed the coverage to see if it would pass, I hadn't paid much attention to the details of the bill.  I'm under no delusions that the United States Government has my best interests at heart, but that being said, I'm not a Republican.  I agree the Healthcare system is badly broken and needs to be fixed, and it will take the government to straighten it out and make it fair for everyone.  Insurance companies do not look out for their insured’s best interest and health, regardless of what they tell you.  I see too many instances of surgery being denied and the patient limping away, only to injure themselves because of their instability and go through more surgery later that was emergent. They deny care everyday to thousands of individuals, citing their medical policies and review by a physician that is paid by said insurance company.  I’m sure if said physician wishes to be paid, he will not approve everything that comes across his desk.  Insurance companies have been allowed to run amuck for too many years now.  Despite this, I grew tired of hearing both sides bicker back and forth and getting nowhere, but sadly this seems to be the norm in Washington.  I tuned it out and went on with my life, trying to help those I could with charitable foundations.  A list of those will be at the end of this post.

Well, now it's been passed, and I'm left wondering...how is going to affect me the patients that come through my door?  This is important to me, because day after day patients come to me because they have no resources to pay their bills.  They have been denied state Medicaid, they can't afford the HIP program, they are not working, and so they have no employer coverage, they've applied for disability and it's in appeal...the list goes on and on.  I won't go into a rant about those individuals who are on state Medicaid and come in with fake nails, the most expensive cell phones, and drive a Cadillac.  That's for another post.

So, what's in this mysterious reform bill?  I refuse to trust biased media outlets to get my information, despite their claims of being "fair and balanced".  So, I went straight to the PDF file of the bill, and realized that I've never liked, nor been able to coherently decipher the language they use.  But, let's see what I can come up with.  It’s 1,018 pages, to be exact, so this won’t all be in one post.  And don’t plan on me reading every single page!

RESTRICTIONS ON PREMIUM INCREASES.—

The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.

 Hrm…well, good and bad.  One person won’t have higher premiums than the other, but the entire group’s rates could go up because of one person being chronically ill and requiring constant treatment.  I think this happens quite a bit with group health insurance plans.  I think the Insurance industry’s response will to just raise all rates across the board. 

SEC. 111. PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS.

A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under

the plan with respect to an individual or dependent based on any health status-related factors (as defined in section 2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.

I’ve heard conflicting accounts of this very important bit of this bill.  It’s for children only, and adults will be added in about four years or so. Not sure about that because I’ve not read further.  But, this is a very good thing!  I have patients who cannot get coverage for RA biologic infusions because it was considered pre-existing.  It should be across the board for everyone, no matter what their age. 

That’s all I’ve time to decipher at the moment.  I did save the bill in its entirely on my flash drive, so I’ll be reading it from time to time and posting about it here.

Now for a list of those charitable organizations.  These links are for help with the cost of medications only.  Some have fees that roll on a monthly basis, so if you need this help, make sure you are applying at the beginning of the month.  Many only cover certain conditions as well, so check out their disease pages before applying.

Healthwell Foundation

PAN

PAF

NeedyMeds

Remember to always check with the company that produces your drug for their assistance programs.  Many are based on income, and you may qualify for free medication.  If you’re on Medicare, Medicaid, or any other federally funded program, you will need to contact the Healthwell Foundation or PAN for assistance.  Government regulations prohibit drug companies from providing assistance to federally insured people.

2 comments:

  1. Cool blog, Angie! I followed the link over from AHA, and I'm impressed!

    I know what you mean about the partisan bickering. I followed the coverage/bill/political summits since I had the time/interest and well, all I can say is this: it was like watching monkeys at the zoo fling poop at each other. Kinda funny and kinda disgusting. Like you, I have no illusions as far as politicians/political parties go, but I'm going to remember some of this for a very long time.

    Between my former job at a children's hospital verifying insurance benefits and helping my ill family members trying to navigate the system, I've seen the best and worst of insurance companies, Medicaid, doctors, medical supply companies and hospitals. I could go on forever about the problems with each one, but suffice it to say that I think anyone who thinks our system doesn't need reform has never been very ill. Our system is rather complex, and it's not patient friendly for the most part.

    Like you, I've read some of that HCR bill, and I think it's sort of a mixed bag and full of unknowns, but at least it's a *start*. I think our systematic problems are far from over though. Insurance is still very expensive (I'm not sure how much the subsidies are going to help) and very difficult for the average consumer to deal with. There are problems with overcharging/fraud/waste. And consumers sticking their heads in the sand about health care has to change. The time to figure out benefits (and I'm talking basic things like copays/coinsurance/deductibles/out of pocket maxes) is not when you get sick or need some sort of care.

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  2. Hey Ali!

    You are so right. I've done pretty much every clerical job you can in healthcare, and there is fraud and waste everywhere. The average patient doesn't see it, of course, but those of us who know it's there have to deal with it as best we can.

    I agree about the "head in the sand" mentality! I see that everyday. I always stress to my patients they need to pay more attention to what their insurance is doing. Sometimes they get it, and sometimes they don't. *sigh*

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