To the Republicans and the NRA, is this a bug or a feature?
A pre-existing condition is, typically, anything you have received medical treatment for within the previous 5 years. This is actually nothing new, as a few commenters above have pointed out. This can result in some non-intuitive weirdness. In my case, the sinus infection I had a few months prior to getting insurance a few years ago (shortly before the pre-existing condition clauses of the ACA went into effect) caused Coventry to put a rider on my plan excluding any health care related to my sinuses. On the other hand, the genetic bone disorder I have, which would be what most people think of when they hear “pre-existing condition” was actually not considered a pre-existing condition because I hadn’t received any medical care for it in over 10 years. So, lucky me. if I had come down with a cold, that would not have been covered. But if I fractured both femurs, that would be.
Exactly. As I have mentioned in a previous post, I think there are only two systems which are financially viable. The one you describe where everyone just fends for themselves, and we let people die if they don’t have insurance, or single-payer universal health care, where we tax everyone for the costs and cover everyone. Everything else is trying to be a little of both, and will never be viable long term. I’m actually hoping the current GOP’s failure to do anything regarding healthcare will make single-payer a realistic outcome.
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Ah, but if you called them to ask, then this is recorded (“for quality or training purposes”). You can tell them, “I called and you said such-and-such. Find the recording.”
One of our cats (all of them formal ferals) has a BB in her rear end.
I apologize if I missed or misunderstood something upthread that renders this comment incoherent. I don’t see how you can be in favor of eliminating pre-existing condition exclusions and also against requiring people to buy insurance. If no one HAS to buy insurance—and if insurance plans can’t deny or screw you for pre-existing conditions—then no one will buy insurance until they know they need it. And insurance will cost way more than it already does.
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I had an entire year of specialist doctor visits and an x-ray and MRI denied because "someone must have put in a wrong code!"
I got that answer 3 years after the first rounds of “what do you mean, my insurance doesn’t cover this?”, and 6 months after the insurance company went out of business under the name on the paperwork. It’s been 10 years, and I still get the occasional call when the account is re-sold.
Sorry you went through all that. Sorry everybody has the potential to go through this. And we haven’t even touched on the 80% of reasonable, customary fees they cover. The insurer’s clerks determine what treatment was reasonable for my conditions, no matter what the doctor said.
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I get the feeling some people think (or pretend to think?) that the health insurance industry was humming along smoothly before Obama went and started screwing around with it for no good reason.
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One thing that people need to remember is that there is a Department Of Insurance that regulates insurance companies. Contrary to what you may suspect, they aren’t at all friendly to insurance companies, at least when dealing with individual cases.
You can file complaints with your state’s DOI, or even the BBB. Make a big F-ing deal about things. File a claim in your local small claims court (if the amount qualifies). With insurance, the squeaky wheel does get the greasing. If you have a valid point, and make it difficult for them to ignore you, either legally through the courts, or from a regulatory standpoint with the DOI, then they’re likely to correct their errors, if only to get everyone off their back (not because it would be doing the “right” thing of course…).
So, be a giant pain in the ass. Ask for transcripts of calls with their representatives. If they refuse, talk to a supervisor and tell them that you can get them in a friendly fashion, or as a court discovery document. If it becomes obvious that you’re going to cost them a lot of money from an employee time/effort or legal point of view, they may make a “business decision” to do the right thing that they should have done in the first place.
And I say this as an employee of a very large national level insurance company…
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But isn’t this part of the problem? Being able to hold these companies to account is predicated on the ability to navigate within the legal system effectively. That’s difficult at the best of times, with some decent resources. Most people don’t even argue with their insurance company over them not paying, much less are able to take it to the next level. And what if you’re in a state where the DOI is led by a “free market” type or the insurance company has an enforced arbitration clause? Because in the latter case, you’re not even going to get into a courtroom, because a judge will be bound to throw that right out, because of the arbitration clause.
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This is why Democrats suck and keep losing elections.
Every Democrat able to get in front of a TV camera should be screaming at the top of their lungs that the Republican congress is trying to make wounded veterans ineligible for health insurance. That under the new Republican rules, anyone whose had a firearm accident can be denied treatment. That the GOP is specifically planning to take health care away from wounded servicemen and law abiding gun owners.
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We use an insurance broker. We don’t pay him, but using a broker is something the Washington State exchange provides for. (Is this nationwide? I don’t know.) Our broker helps us navigate the labyrinth and acts as our advocate. If we don’t understand something, we email him. If we need him to walk us through something, he does. And if (when) we get screwed by our insurance company, he’ll help us.
I think that if you get shot, it’s important not to have the gunshot diagnosed.
Like a chump, I had some varicose veins in my leg diagnosed in 2016. Not really anything they can do about them, but now they’re on the record. How long until that comes back to haunt me? On the other hand, my family is basically uninsured, so maybe it doesn’t matter.
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As far as I know, that’s not something that’s universally available. There are navigators in other states, but in some cases, they are overwhelmed by requests for help and many of these are entirely volunteer, meaning it’s unpaid labor and therefore more limited on what they can do?
But I was more responding to @Bobo idea that we as consumers of insurance should be responsible for protecting ourselves. My point was more about how some people aren’t really in a position to fully advocate for themselves (people with poor health who need care ASAP or the working poor, without recourse for adequate legal help). An insurance broker seems like it would help on the front end (deciding on insurance and navigating an exchange). I’m not sure it would help on the legal end when the insurance company is refusing to cover care for whatever reason.
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You may want to keep in mind that that is not some mere academic exercise where debating the theory is all we have. We can look at countries with much less in terms of people and resources and see that universal healthcare does a much better job than what we currently have. Places like the Czech-Republic is kicking our butt in infant mortality rates so clearly our current system is a failure. Secondly, we need to remember that in all of your “equations” you are making the mistaken assumption that healthcare costs represent the cost of healthcare; a serious misconception many make when considering the two systems. Finally, as far as your suspicion that evil politicians and curb kickers will spoil the system, you’ll have to provide some example of that happening in places where universal healthcare is in operation. Otherwise it just smacks of crying wolf in order to introduce fear, uncertainty, and doubt - a common tool of the establishmentarian.
[quote=“anotherone, post:94, topic:104164, full:true”]
You may want to keep in mind that that is not some mere academic exercise where debating the theory is all we have. We can look at countries with much less in terms of people and resources and see that universal healthcare does a much better job than what we currently have. Places like the Czech-Republic is kicking our butt in infant mortality rates so clearly our current system is a failure.[/quote]
Except that only matters if what we’re debating is the quality of health care. While I want better healthcare for us, that’s not the debate going on about the healthcare bill. The bill is all the cost to the government for providing any care along with the individual share of the cost, and how many people actually get that care. There’s only a passing semblance of talk about if the care is any good.
I included all the other stuff as overhead, it’s right there in the number. Specifically broken out so it’s not missed.
It’s an honest question, not crying wolf. An honest question to figure out. The debate that we’re not going to cover stuff, not going to have a backstop for regular care, but once you’re destitute, completely broke, and in need of what’s now emergency services, so NOW we’ll finally pay is the crazy position. There’s no way that’s the best economic plan. And, this is really an economic question and not a healthcare one.
At an economic level, it’s either better to provide care all along the way and avoid costly emergency service at the end. Or, it’s better to just provide nothing.
The magic plan of proving nothing right up until the end and then paying for the most expensive stuff is the least efficient and least productive plan.
But, when politicians say they don’t want to provide the early stuff, and also don’t want to kick you to the curb, they’re pandering to the worst possible outcome. We need to hold them to it, get them to either say they don’t want to provide the care ever. Or, point out that the current plan is the least efficient, most expensive, worst care, and worst financial picture possible. The current plan is one big gamble for every individual.
In that case you aren’t buying insurance on the individual market, so it doesn’t come into the equation.
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What a coincidence that the armed, union members of this society aren’t affected by this.
Indeed. Though i would have had the same response in regards to teachers,
sanitation workers, and any other unarmed, unionized public sector employee.
And companies to a large degree depend on this. But, there are relatively low cost ways of being a giant pain in the ass to an insurance company, both in ways that they are legally obligated to respond to (DOI complaint) as well as ones that they’re not obligated to, but very much want to make go away (BBB complaint).
The arbitration thing, I have to admit that I’m not familiar with because my company doesn’t have that (at least for my particular branch).
That’s probably true enough, but I’d still argue it’s harder for poorer and sicker customers to do so.
Quite frankly, I find arbitration to be a pretty underhanded means of cutting out the legal system. It’s contract law meant to help the company, not the consumer. It’s not just in the insurance world either. These clauses are popping up all over the place as a means to ensure that lawsuits can’t happen.
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