October 5th, 2010 
Vijaianand Around 10-15 million Americans are without job and around 45 millions don’t have any Health Insurance coverage as per reports. So we cannot be sure about how the new Health Care Act is going to help achieve its set goal of making the not insured count go down when it takes effect starting in 2014. With Mr. President opponents(republicans) grapling about Health Care Bill and doing everything possible to repeal the act. It is not sure whether major changes of health care act will ever effect. So it is encouraging and good news to hear some part of the act is taking effect as of Sept 23rd, 2010.
Being self employed and carrying Individual Health insurance, I always look out for changes in health care to see whether it makes our life easier and save some money. The changes which took effect on Sept 23, 2010, seems to really add value to the consumer and makes good sense. Here are the details about changes so you can apppreciate it. If you are group health plan holder, you won’t be thrilled about since everything is covered in group coverage.
What Insurance companies can’t do anymore:
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Deny coverage to kids with pre-existing conditions. Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition like asthma. This is a big blessing for many parents who already suffereing because of their kids pre-existing conditions. Now Insurance companies have to cover them. It might be expensive but alteast coverage gives discounted price on the services provided.
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Put lifetime limits on benefits. Health plans can no longer put a lifetime dollar limit on the benefits of people with costly conditions like cancer. With medical cost skyrocketing these days, any person with serious medical condition, this is big bonus so they don’t have pay from their pocket after lifetime benefits are finished.
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Cancel your policy without proving fraud. Health plans can’t retroactively cancel insurance coverage – often at the time you need it most – solely because you or your employer made an honest mistake on your insurance application.
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Deny claims without a chance for appeal. In new health plans, you now have the right to demand that your health plan reconsider a decision to deny payment for a test or treatment. That also includes an external appeal to an independent reviewer. This makes sense because you have the right to appeal or review which many times helps to get the cliams paid. Many insurance carriers already provide this opportunity but making it a compulsory in the agreement would force them to do proper claim service.
What consumers get when they renew or buy new Health Plans:
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Receive cost-free preventive services. New health plans must give you access to recommended preventive services such as screenings, vaccinations and counseling without any out-of-pocket costs to you. Many insurance carriers already provide this option with limitation on the expense like $300/year. I am not sure whether the new law changes and takes away the limitation or not.
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Keep young adults on a parent’s plan until age 26. If your health plan covers children, you can now most likely add or keep your children on your health insurance policy until they turn 26 years old if they don’t have coverage on the job. This might e a burden to many parents but kids without insurance is bad compared to having them in your plan until they can financially support themselves.
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Choose a primary care doctor, ob/gyn and pediatrician. New health plans must let you choose the primary care doctor or pediatrician you want from your health plan’s provider network and let you see an OB-GYN doctor without needing a referral from another doctor.
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Use the nearest emergency room without penalty. New health plans can’t require you to get prior approval before seeking emergency room services from a provider or hospital outside your plan’s network – and they can’t require higher copayments or co-insurance for out-of-network emergency room services. This change is a big plus for many elderly and many with serious medical conditions who use emergency a lot.
Overall, these new changes seems to add value to the insurance policy but Insurance carrier are sure to shove the expenses related to these changes to the consumer. Because of that, you are going to see some big jumps in the insurance cost in coming years. Check out more details and webcasts about this change from healthcare.gov
Source: healthcare.gov
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