From Georgia Gordon:
“Dave, can you use this? We have first hand experience dealing with health insurance and their denials of DOCTOR prescribed treatment.
My beautiful daughter who has been a responsible, productive, member of our society, contracted Lyme disease along with two co-infections It has affected her brain along with the rest of her nervous system.
It took nine months of Anthem Blue Cross using delay tactics with their denials and our appeals before they approved the IV antibiotic that was required to penetrate the blood brain barrier. They reluctantly approved one month of treatment, when Lisa needed three months of treatment. Anyone who does not have an advocate looses the battle. Especially someone who is so debilitated by spirochetes in their brain that they have lost the ability to concentrate while all the time more damage is being done during the wait. It is an ongoing battle, The insurance company just denied one of the oral antibiotics that she was recently doctor prescribed. These remote reviewers want to decide treatment and their decisions are always based on saving the company money. No wonder people have died waiting for treatment. Anyway, good information below from the White House. I thank you for reading all of this:”
“Since the House of Representatives voted to pass health reform legislation on Sunday night, the legislative process and its political impact have been the focus of all the newspapers and cable TV pundits.
Outside of DC, however, many Americans are trying to cut through the chatter and get to the substance of reform with a simple question: "What does health insurance reform actually mean for me?" To help, we've put together some of the key benefits from health insurance reform.
Let's start with how health insurance reform will expand and strengthen coverage:
- This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone.
- This year, health care plans will allow young people to remain on their parents' insurance policy up until their 26th birthday.
- This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need.
- This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool.
- In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.
- This year, we'll also establish an independent commission to advise on how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our country's needs. Going forward, we will provide $1.5 billion in funding to support the next generation of doctors, nurses and other primary care practitioners -- on top of a $500 million investment from the American Recovery and Reinvestment Act.
Health insurance reform will also curb some of the worst insurance industry practices and strengthen consumer protections:
- This year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.
- This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.
- Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance companies.
- Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don't meet those thresholds will be required to provide rebates to their policyholders.
- Starting in 2011, this bill helps states require insurance companies to submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.
Reform immediately begins to lower health care costs for American families and small businesses:
- This year, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.
- This year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same.
- This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.
- This year, this bill starts to close the Medicare Part D 'donut hole' by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50% discount on prescription drugs in the 'donut hole.'”
Director, White House Office of Health Reform