Tag Archives: insurance

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Three quick things you should know about Obamacare


Three quick things you should know about Obamacare

Hi all —

In the past few days, we’ve received three really interesting new pieces of information about the health care law, and we wanted to share these data points with you so that you get a big picture of how things are changing for the better as the law gets implemented.

First, the Affordable Care Act is helping to make sure that insurance companies and providers have to compete for your business by creating a Health Insurance Marketplace that offers people more choice and control over their insurance choices. An estimated 80 percent of the people who will enroll in the Marketplaces live in states with five or more different insurance companies to choose from — instead of just one or two. We’ve put together a memo about that, and you can read it HERE.

Second, as the health care law is helping move to a system where data helps improve consumer choices and the quality of care, the government is making more information available to consumers, from hospital charges and quality outcomes to regional health care system performance statistics. Those may sound like dry things, but businesses are springing up across the country and using this data to power new innovation. Secretary Sebelius explains this idea in more detail HERE.

Third, we got some great news about the long-term viability of Medicare. Program cost growth, both long term and short, is down — even as new benefits for preventive care and prescription drugs are now helping tens of millions of beneficiaries. Get more information about the report that shows that Medicare is growing stronger HERE.

We’re sharing this information with you because we’re sure you hear people talk about the health care law in your communities all the time, and if you have questions we’d love to answer them.

Ask your questions about the health care law, and we’ll answer some of them next week.

Thanks,

Tara

Tara McGuinness Senior Communications Advisor The White House

P.S. — Earlier today, the President delivered remarks on the health care law in San Jose. Lean more HERE.

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Judy Waxman, National Women’s Law Center


National Women's Law Center
Getting the coverage you deserve!
                What to do if you are charged a co-pay, deductible, or co-insurance for preventive services.
Download Toolkit

We’ve been working hard to make sure you and your families know about the preventive coverage provided through Obamacare. We’ve heard from many women about how much this coverage has helped them!
But we’ve also heard about some women encountering problems while trying to get these services without cost-sharing. Have you gone to the pharmacy to get your birth control thinking you wouldn’t have a co-pay — only to find out that you did? Or have you gone to the doctor thinking your annual visit would be covered without a co-pay — but it wasn’t? When your insurance company isn’t working for you, we’re here to help.
Check out our newest resource: “Getting the Coverage You Deserve: What to Do If You Are Charged a Co-Pay, Deductible, or Co-Insurance for a Preventive Service.”
Thanks to Obamacare, health care plans under the reach of the law must cover women’s preventive health services like mammograms, birth control, and breast feeding supplies without imposing deductibles, co-insurance or co-payments. But some insurance companies are still, incorrectly, making us pay for these services. So we’ve created an easy-to-use resource for you to make an appeal to your insurance company when you’re incorrectly told to pay for your preventive care.
Check out our resource today and make sure you’re getting the health care you deserve!
Want to learn more? Visit www.nwlc.org/preventiveservices.
Sincerely,
Judy Waxman Judy Waxman Vice President for Health and Reproductive Rights National Women’s Law Center    

P.S. If you have a question about using the toolkit, or you have trouble getting a preventive service covered and you’re unsure why, let us know! We might be able to help. Please contact us at 1-866-PILL4US or via email at pill4us@nwlc.org.
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Obsessed


By ThinkProgress War Room

37th Time’s the Charm?

Tomorrow, the Republican-controlled House of Representatives will once again vote to repeal Obamacare. If this sounds familiar it is because it is the 37th time — yes, that’s 3-7 — that House Republicans have tried to repeal Obamacare.

This obsession has not come for free, either in terms of time nor money. One estimate pegs the cost to taxpayers of these 37 repeal attempts at some $55 MILLION. What could we do with that same $55 MILLION? Here’s four ideas:

1. Restore cuts from sequestration to Title X family planning programs and Title V maternal and child health services. The National Women’s Law Center calculates that a 5 percent cut to the budgets of each program will reduce them by $15 million and $32.5 million, respectively. Rather than voting to repeal a bill that expands women’s access to preventative services, the House could use the money to expand them.

2. Double the Department of Justice’s budget for sexual assault services, which has currently been authorized a $50 million budget. The program gives money to states so that they can support rape crisis centers and other nongovernmental organizations that provide direct intervention, core services, and other assistance to the victims of sexual assault. Current funding is inadequate, as some states receive less than $300,000 and many programs lack the resources to meet victims’ needs.

3. Grant a request for $50 million to train 5,000 new mental health professionals as part of a new initiative to expand mental health treatment and prevention services. This proposal came in the wake of the Sandy Hook shooting to address gaps in the mental health system.

4. Help states implement paid leave policies. President Obama included a $50 million State Paid Leave Fund in his 2011 budget to provide start-up support for states that want to enact paid leave for workers. More than 40 percent of workers don’t have access to paid sick leave, heading to work when they or their family members experience an illness, but this funding could help give them a better option.

In terms of time, this calculation from the New York Times shows why this is one of the most unproductive Congresses in history:

That means that since 2011, Republicans have spent no less than 15 percent of their time on the House floor on repeal in some way.

The real cost, of course, comes in terms of the more than 100 MILLION Americans who would be harmed by the GOP’s obsession with taking away their health care benefits, including:

  • 129 MILLION Americans with pre-existing conditions who will once again be at the mercy of the insurance companies.
  • 105 MILLION Americans would see lifetime limits on what their insurance company has to cover, which Obamacare banned, put back in place.
  • 71 MILLION Americans, including 34 MILLION seniors, who are currently eligible for no-cost preventive care, including mammograms and birth control.
  • 18 MILLION middle-class Americans who will receive a tax credit averaging $4,000 a year starting next year.
  • 17 MILLION children with pre-existing conditions who today, as we speak, cannot be denied coverage.
  • 13 MILLION consumers who received more than $1 BILLION in rebates last year because of an Obamacare rule requiring insurers to spend 80 percent of premiums on actual medical care would no longer be eligible for such rebates because insurers would no longer be held to such a standard.
  • 6 MILLION young adults who are currently able to stay on their parents’ insurance — 3.1 MILLION of whom were previously uninsured.
  • 6 MILLION seniors who are receiving discounts — more than $6 BILLION worth so far — on their prescription drugs thanks to Obamacare.

In addition, repealing Obamacare would increase the deficit by more than $100 BILLION over the next ten years and eliminate new resources to fight fraud. These fraud fighting efforts have recouped $4.2 BILLION just this past fiscal year from those seeking to defraud seniors and taxpayers.

BOTTOM LINE: The GOP’s obsession with taking away health care benefits from more than 100 MILLION Americans is a waste of time, a waste of money, and harmful to the tens of millions of Americans already benefiting from Obamacare.

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14-y-o Morgan needs this treatment to live


                          BlueCross BlueShield NC should cover the life-saving treatment for Amy’s daughter they promised to pay for                                               
                      
      Sign the Petition

BlueCross BlueShield North Carolina: Keep your end of the deal and pay the claims

Started by: Amy, Wesley Chapel, Florida

My daughter needs IV treatment each month to fight a debilitating and life threatening auto-immune disease called Dermatomyositis. BlueCross BlueShield of North Carolina is denying claims for vital treatment. When you pay your insurance premiums and do what you are supposed to do, the insurance company should do their part and pay for the appropriate treatment. Instead, when we called the BlueCross BlueShield to get approval for her life-saving treatment, BlueCross told me and the hospital that that we didn’t need pre-authorization. Then, they changed their mind and now want my family to pay a bill of $240,000.

Since the CEO just got a $1.6 MILLION bonus for 2012 from revenues of $5.7 Billion, it doesn’t appear that costs are a concern. Patrick Getson, a VP, got a $232,788 BONUS for 2012. Please sign my petition to tell BlueCross that they need to do their part and live up to their responsibilities to us as subscribers to their policy. We did what we were supposed to do, and they need to do what they are supposed to do and pay for these claims.

Here is what happened…

My daughter Morgan has been fighting a rare autoimmune disease for almost 3 years. She was diagnosed at age 11, and she went from being a tremendous athlete to being unable to ride her bike, walk up the stairs, or play sports. After over a year of trying to find an answer to the problems, we finally got a diagnosis of Juvenile Dermatomyositis, a rare auto-immune disease that affects the skin, muscles, and the vascular system which causes problems all over the body like joint pain, severe headaches, GI issues, and sometimes heart and lung issues as well. Since she was diagnosed, we have known several children who have died from this disease, and we have done everything we can to make sure that she is getting the correct treatment.

The very first thing we did is to make sure we had adequate insurance coverage. We already had great insurance, and we backed that up by increasing the amount we put into HSA accounts. We found the right health care experts as this is a rare disease and not many peopole know much about it or how to treat it. We followed treatment recommendations to the letter and we learned as much as we could about the disease. We modified our entire life behavior to help reduce the chances of her disease getting worse by doing things like staying out of the sun and skipping pool and beach trips because the sun makes her disease worse.  As she was treated, the first line treatments weren’t helping and she was getting worse. The doctors said that she needed to be admitted to get the second line treatment. Once again, we did what we were supposed to do, and we made sure the hospital called the insurance for authorization. Each and every month, the hospital called and spoke to BlueCross of North Carolina on the phone. Each month, they told the hospital that authorization was not required.

The second line treatment is an infusion called Introvenous Immunoglobin (IVIG). This medication has been like a gift from God and it has made a HUGE impact on her disease. She gets it every four weeks, and we can always tell when it is close to the time to go back as she starts getting worse again. As soon as she gets the treatment, we see improvement again. It is not a fun treatment for her to get. She has to be in the hospital, has to get an IV inserted, is woken up ever hour during the night to be sure her vitals are stable, and she suffers extreme headaches after it. But, she gladly goes without complaining because she knows it helps her.

BlueCross paid some of the claims for her treatment and denied others. The hopsital was confused as they had followed the same authorization process and billed them exactly the same way. They tried appealing them first without even telling me what was going on. By the time I knew they were appealing these odd ones, BC had then denied many, many more items. I called them thinking it was just some weird mistake since it was approved one month, denied the next, approved the following. They said that a person had reviewed the ones that were denied and a machine had approved the ones that had been approved.

I have formally appealed their decision based on the fact that the hospital called for authorization each time and was told it wasn’t required. They have denied the appeal saying that it has been their policy since 2010 that it requires authorization and that the fact that we didn’t know that isn’t their fault as it was buried in their policies. This makes absolutely NO sense since we DID try to get authorization. How do you get authorization if you are told you don’t need it when you ask for it?

I have already spent countless hours on this appeals process and many sleepless nights worrying about being bankrupted by this $240,000 bill. Additionally, I worry about how she is going to get the treatment in the future as I am still having some issues with approvals even now that we DID finally get them to write an authorization for a year. Just getting that letter required talking to many people and demanding it as they kept telling us it wasn’t required.

Thanks for your support, and I wish you and your family good health. All of the sudden, we were thrown into this health care mess the day she was diagnosied. We need to hold insurance companies accountable. Unfortunately, from talking to others, this type of experience is far too common.

Click here to sign Amy’s petition, “BlueCross BlueShield North Carolina: Keep your end of the deal and pay the claims”.

You can also check out other popular petitions on Change.org by clicking here.