Chronic illness has shaped my career. Kairol Rosenthal is a fellow traveler who found that illness can lead you in new directions-if you let it. I’ve asked her to guest post this week because her information is so critical for all of us.
Kairol Rosenthal was diagnosed with cancer at 27 and discovered two days later she had been dropped by her insurance. She has spent the last decade fighting for her own health insurance, and researching and writing Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s.
Living with chronic illness is hard enough without the dizzying language of health insurance red tape. I wanted to make the Sept. 23 health insurance changes easier for all of us to understand, so I’ve adapted the Campaign for Better Health Care Guide with a bent on chronic illness.
Feel free to ask questions in the comment section below. Remember, these new regulations are now law. You should hold insurance companies accountable so you can get the maximum protection and coverage guaranteed to you.
The below changes apply to plans beginning or renewed after September 23, 2010. For many people this means the provisions actually take effect when they renew their plans in early 2011.
1. NO MORE RESCISSIONS (A.K.A. GIVING YOU THE BOOT)
Insurance companies can no longer cancel your coverage for unjust reasons, a practice known as rescission. Before, if an insurance company got hit with a big claim, they could find an unintentional error on your application (even from years ago) and use it as a basis to deny you coverage; not anymore. This applies to all insurance plans. FYI: If you intentionally commit fraud or hide something on your application, your insurance company can still rescind your coverage. Your insurance company must give you 30 days notice before rescinding coverage to give you time to appeal.
2. RIGHT TO APPEAL INSURANCE COMPANY DECISIONS
You’ll now have the right to appeal decisions your insurance company makes about your health care (such as refusing coverage) to an independent, third party reviewer. This appeals process will vary by state and by plan. FYI: This doesn’t apply to grandfathered plans. Learn what qualifies as a grandfathered at FamiliesUSA, Number 4 under ‘Big Picture’.
3. NO MORE LIFETIME CAPS
Insurers are now not allowed to set limits on your lifetime benefits coverage, no exceptions. You will no longer have to worry about “capping out” on your coverage. FYI: There are still annual benefits caps that have been raised to $750,000. These will be fully eliminated in 2014.
4. FREE PREVENTIVE CARE
Your insurance plan must cover preventive services and screenings, without co-pays or deductibles. The full list is long and includes mammography, colorectal and cervical cancer screening, depression screening, counseling for sexually transmitted infections, many adult immunizations, and many forms of pregnancy care. FYI: “grandfathered” plans don’t have to comply with this rule.
5. COVERAGE FOR YOUNG ADULTS
If you’re a YA without health insurance, you can be covered under your parent’s plan up until your 26th birthday. This includes YAs who are married and YAs who aren’t students. FYI: Young adults that already have a health insurance offer through an employer may not be eligible.
6. NO DENYING KIDS WITH PRE-EXISTING CONDITIONS
Insurers are required to provide coverage to children (up to age 19) with pre-existing conditions, like asthma or hemophilia. This applies to families with group plans and “non-grandfathered “individual plans. FYI: “grandfathered” individual plans don’t have to comply with this provision (though group plans do), and some insurance companies will no longer offer child-only policies.
For tips on how to cope with everything from managing medical debt to chronic illness and sexuality check out Kairol’s blog Everythingchangesbook.com
Oxygen Monitor : says
of course health insurance is very much essential for your own sake`::
Tammy says
But insurance companies are very good at stalling and, if the illness is a matter of life and death, an appeal will not occur in a timely manner. HealthNet is partially responsible for my only daughter’s passing, as are local hospitals and physicians. Unfortunately, health care reform must also include revision of antiquated hospital policies. There needs to be a checks and balances for the chronically ill in order to expedite matters and if the physicians states the patient needs it, no questions should be asked! But what do you do when you have a physician who is unwilling to refer outside their own hospital, or a physician who makes the statement “why do you want to see that physicians as he knows nothing more than I”? What do you do when the hospital states “if you seek care for your loved one elsewhere, you will no longer be welcome at this hospital unless they are on their death bed”?
Rosalind says
Thanks for saying this, Tammy. Because unfortunately, these things do happen and even once, is one time too often. I am deeply sorry that this happened to you and your family.
Kairol Rosenthal says
Tammy,
I am so sorry to hear about your daughter’s passing the horrible role that health insurance played in that process. You are right, when it is a matter of life and death, appeals processes, as we currently know them, can take longer than is medically practical. This is why it is so important that as patients and family members we become active advocates at this stage of health care reform. Because the appeals process will vary from state to state, it is important that we each become active in putting pressure on our state governments to make these new regulations as stringent as possible to allow for expedited appeals.
With these new guidelines comes more competition in the market, which will hopefully give us as consumers greater choice to switch carriers. How much more power we will actually have in these situations remains to be seen. I feel that it rests on my shoulders to do what I can to make the new policies as stringent as possible so that nobody ever has to go through situations like I and your daughter went through.
I cannot image how it felt to be told “if you seek care for your loved one elsewhere, you will no longer be welcome at this hospital unless they are on their death bed”. A few things to do for others who might be in that situation:
1. Contact your state attorney general’s office and find an advocate who can tell you what your rights are as far as a hospital turning you away for care.
2. Contact the hospital’s ombudsman, chief medical officer, chief operations officer, and the legal department (they usually have some cheesy name like ‘patient resolution department’). Tell them what the doctor said and request an in-person meeting to resolve your problems. The doctor’s comment sounds not only horrible but potentially illegal. When hospital admin knows that I am garnering grounds for legal action, boy do they roll out the red carpet for me. I don’t ever have to take legal action or even outright threaten it, but I certainly send off the vibes that I am prepared, competent enough, and organized enough to do so. I don’t go crazy on them, instead I make the squirm with a forceful, calm, and aggressive presence. I have been taken very seriously I have been taken very seriously in these situations.
3. Report the doctor to your state medical board.
Lastly, all good doctors are happy to have a patient see another doctor because they want to learn from each other. If any doctor says to a patient “why would you see another doctor?” find a way to humor them, get the referral (if you can!) and get the heck out of dodge! It is a big red flag.
Tammy – again I’m so sorry for your loss! Hang in there and thanks for your comment.
Best,
Kairol
Rosalind says
And thank you, Kairol, for jumping and responding to Tammy’s note. I was completely stuck on how to respond and you gave tremendous empathy, but more important, valuable information that I hope she can use.
Chrome Towel Radiator says
health insurance should only be taken from reputable companies, you really don’t want to get it from fly-by-night companies :’*
Jennifer says
I am not clear on how you get the free preventative care… I am assuming in my case I will need to meet my $$$$$ deductible and see my PCP or a specialist or two to get them to prescribe the preventative…not free in my book.
Also, my OOP for medical for 2011 will go up ~10% not including what I spend on premiums. I am told this is due to healthcare reform…
Rosalind says
I don’t know the answer to your questions but have forwarded this to Kairol – Let’s see what she says!
Jennifer says
Sure would like advice on this if anyone has any.
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