New health reform rules guarantee patients the right to petition insurer
Article Source: msnbc.com
from:msnbc.comHospital bill not covered? Now you can appeal denied claims
Seeded on Thu Jul 22, 2010 1:17 PM EDT (msnbc.com)
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My employer has just notified me, by letter, that the new Health Care bill signed by obama (named him in the letter) makes it necessary to raise my premiums and out of pocket expenses, they are also putting lifetime limits on some illnesses and procedures (haven't told me what these are yet). Of course every gang banger, hoodlum and leach will have insurance coverage, yippee. Thanks a lot obama and congress. Several years ago my wife was ill and we ran up over $750,000 in medical bills, my insurer said only half of that was qualified expenses and I would have to pay the rest. I went to a lawyer (told me it wouldn't cost anything unless it went to court), he wrote the insure a letter stating he could see anywhere in the policy where it said the services weren't covered. The insurer sent me a letter a week later and said they had reviewed the case and would pay the remaining balance. You can bet your bottom dollar we are going to pay more for less and the insurers will be very specific on what's covered and what isn't, and it won't do you a bit of good to protest the charges. They are smart enough to know the rules and what they will be able to get away with. Hope you people that voted for obama are enjoying the change!
Hope you're enjoying that lying, scumbag insurance company you currently have. (After 2014, they CAN'T have lifetime limits for any illness or procedure under the new healthcare legislation. Maybe until then, but they could have gotten away with it forever if the bill hadn't passed.) So your solution was to leave these greedy SOB's in total control of what they pay for and what they charge? Thanks, but I"ll take the change. It would have been better, but the GOP wouldn't go for a single payer option.
What did you or your favorite politicians do to prevent our healthcare system from becoming what it is? You do realize that these costs and price pressures on premiums have been going up for decades, and that it's gotten far worse in the last 10 years? You express a concern about lifetime limits - but you do realize that unlimited care is infinitely expensive - how do you plan to pay for that? Taxes? So do you want unlimited care, or do you want a fiscally responsible healthcare system? You can't say you want both and blame Obama for not giving you either, unless you're just prejudiced against him for oh, I dunno, *some* reason.
And you claim that every "gang banger, hoodlum and leach (it's spelled "leech" by the way)" will have insurance coverage. What in the hell are you talking about? Is it a doctor's or hospital's job to decide whether someone is a law-abiding citizen before they treat them? Do you want someone to have that power over you if you cause a car accident and the doctor thinks you deserve to die because you killed a little girl?
I know I'm asking for a lot, but please, try to put half a thought together before you grind your Obama-axe. He's not the saviour, but at least he's trying, which is more than Bush or the rest of the Republicans ever did in the 8 years they had the run of the land.
lifetime limits are no longer allowed on plans that either are initially written after 9-23-2010 or on thier next renewal date after 9-23-2010. Someone is lying to you about the lifetime limits.
Check with your local state department of insurance.
Change for the worse and hope the $23,000,000 Obama sent to Kenya made him a local hero.
At least he tried to do something about the way insurance companies, and the health care system in general are bilking the American people. The safe alternative was to do nothing, and let healthcare costs spiral upward as it has been doing, to the point where most people wouldn't be able to afford any kind of health care. In that scenario, you would see a future where employers (and not just small businesses) would start to drop health insurance, and instead, give their employees a contribution to buy their own insurance.
Most probably won't agree, but a national health care system is necessary, and long overdue in the U.S., like it or not.
I agree with only some of your comments. The main problem I have with the new health care system is that it took out $500 million out of Medicare to partially pay for the rest.
That is why many doctors are dropping out of Medicare, one by one, and refuse to take new patients.
With Obama bailing out giant corporation with hundreds of billions of dollars, seniors should not have been short changed.
Antonio, he too $500 million in INCREASED projected payments of Medicare. You do understand that we will be still spending more on Medicare right?
This article in the NYTimes shocked me.
http://www.nytimes.com/2010/07/21/us/21aging.html?ref=health
Antonio, Bush raided the medicare trust fund. Doctors are dropping out of medicare because thier reimbursement rates NOW are too low.
What a crock of S**T! Trying to sell the American people on a totally screwed up bill. BTW - Anyone realize this bill also put Millions of dollars into the 'Historically Black Colleges'? Yup, really belongs in a Healthcare Bill - NOT! Stupid Congress (both the Republicans & Democrats). PLEASE - remember in both your State Primary and General Election ---> TIME FOR A CHANGE!
As stated by others: What is the difference? We can appeal now. the only difference I see is the wasted spending to get the message out. (Probably written in foreign languages for the illegal immigrants - LOL)
Please direct us to that stipulation's location in the bill. I would have to agree w/ you if you could prove your statement with a direct answer/proof of its existence.
Washington (AP) — Riding the coattails of a historic health care vote, the House on Sunday also passed a broad reorganization of college aid that affects millions of students and moves President Barack Obama closer to winning yet another of his top domestic policies.
The bill rewrites a 40-year-old student loan program, eliminating its reliance on private lenders and uses the savings to direct $36 billion in new spending to Pell Grants for students in financial need.
In the biggest piece of education legislation since No Child Left Behind nine years ago, the bill would also provide more than $4 billion to historically black colleges and community colleges.
You can copy and paste the link if you need to reach it directly
http://edlabor.house.gov/newsroom/2010/03/miller-health-care-bill-will-i.shtml
From what Carla just wrote it looks like the government saved money by cutting our reliance on private lenders and passes the savings on in pell grants to students.
If true no wonder there are some who are pissed off the "Private Lenders" Boo Hoo to them!
BTW, I have no problem with more funding for schools even "Historically Black Colleges", I really don't get what "Dogsinight" is whining about.
Carla, did you really just post that? So, basicaly, Obama did something great for education? Good for him! You do know your quote states that he ADDED $36 billion to pell grants from savings right? I am glad you support Obama too!
Thank you Carla for responding :-)
My complaint is two fold:
1. What does Educational Grants have to do with Healthcare?
2. Why specify any certain race or color? I thought our new President was going to try to stop building those barriers. Obviously, he is okay with his Congress building up those barriers.
Food for thought... Why is it "racist" for an ALL WHITE college, but acceptable for ALL BLACK colleges? What about ALL SPANISH, ALL GERMAN, ALL JEWISH, ALL CATHOLIC, etc... Let's stop the race and color bulls**t. We are Americans, regardless of historical breeding and color.
PS> Simon: I would agree with you, IF it was done in it's own seperate bill. Too bad Congress disagrees and would not pass such a bill. They had to HIDE this in a Healthcare bill to get the legislation passed. (Kinda like hiding a Birth Certificate or having an illegal immigrant relative LOL)
@dogsinsight
There is no conspiracy here...why did they put it in the healthcare bill? Well, we can only speculate but I'd argue that if they didn't it would not have passed because the banks would have lobbied that piece of legislation to death-and this is a good piece of legislation for our kids.
Smarty_pants:
Are you sure this Legistaltion is a good thing for our kids? Who is going to pay off all of the debt being incurred by this new legislation? The answer: Our kids
Yes, the concept is a good idea. However, please read the following:
"In the end, to satisfy budget requirements and win over skeptical deficit hawks in their own party, Democratic leaders wound up directing a total of $19 billion (of the $61 billion in revenues that the student loan shift would produce over 10 years) to reduce the deficit and help pay for the health care portion of the legislation."
Still think it's a good idea for our kids? Using the savings from government run educational loans to repay the Healthcare deficit?
Quote from : http://www.usatoday.com/news/education/2010-03-19-IHE-student-loan-measures-in-health-bill19_ST_N.htm
Dogsnight, I really don't understand what you are whinning about the goverment makes money loaning money to students and uses some of the profits to pay off the deficet.
The deficet has to be paid off the surplus that was in the treasury was pissed away under Bush and you seem to want the goverment to do what (Nothing) with that surplus?
As for health care that has to be paid and this is a good way to help do it. Please explain what you would do to pay off a deficet started under Bush? Someone has to pay for Bush's reckless policy's! Who do you think should pay or how should it be paid?
Thank you for asking that question. Please note, I do NOT care who created the deficit. What is done, is done. (BTW - It was not Bush's administration, it was the People's Congress, including the President & Vice President, that the people elected)
Here are a five ways I believe we can reduce the deficit:
1. Remove all illegal immigrants from our government paid programs.
2. Bring our soldiers home (as promised) and reduce our defense spending.
3. Stop the free hand-outs to failing BIG businesses. (So what if the American auto companies fail. It's their own damn fault. Another will build right after those failures leave)
4. Set a cap on financial aid to foreign countries per year. (Makes the government think twice before spending millions of dollars every time another country cries out for help)
5. We have an annual budget. STOP APPROVAL ADDITIONAL SPENDING NOT IN THE BUDGET! (There should be very few times where we need to approve an emergency spending.)
And while at it:
I believe all bills in Congress should be specific to the cause (i.e. The education within a healthcare bill)
I believe there should be term limits on both the members of the House and Senate
PS> Yes, I do plan to run for US Rep in 2012
you've got my vote!!
Dogsinight, you seem naive you said "You don't care who caused the deficit" that means you will be part of the problem if elected.
Republicans did not care when they spent our country into a deficit ether you sound just like them. Education is always a good investment it helps people get a bigger paycheck and more tax revenue for government programs like roads.
As for handouts to big business you might be right if it pertains to wall street and big banks a strong manufacturing base is in our country's defence interests. Also Detroit has always paid back their loans I don't know about wall street and they always seem to hold the tax payer up every decade it started with Reagan.
The bill was called "The financial reform and immigration control act of 1987" or was it 86? Not sure which year it was but check it out.
If you don't believe me look it up about Reagan as for term limits it's a idea that has it's merits. But you left out a few things that would make our elected officials more honest.
For instance "When our elected officials leave office they cannot become a paid lobbyist" as it stands right now when they leave office they get a overpaid lobbyist job. It makes it easier for the elected officials we got in office now to pass laws that are not in the "Peoples" best interests.
That's why we have the financial mess we got right now because of "Special Interest Lobbyists". You can also look up the "Gram,Leach,Bliley act of 1999" two Nobel prize winning economists have stated that passage of this bill was the cause of the "Financial meltdown of 2008" that bill sponsors are all republicans.
You should also look up "Reinvestment Act" it was the start of a lot of the problems we got now. If you plan running as a republican forget it they are crooks.
Last "Whats you real name"? If you plan on running for elected office we deserve to know who you really are. But if you do get elected "BE Honest".
Dana Glow - New Ipswich, NH 03071
As you can tell, I will be running as a Republican in 2012. However, I will always vote based on the American People's majority of consent. If it means I would support a Democratic Bill, so be it. As long as it is in the best interest of the American People.
Why did I state "I do NOT care who created the deficit"? Because I believe that dwelling on the past will NEVER move us into the future! (Of course I care, but not as much as I care about our future)
Thank you for time and replies.
'According to the Congressional Budget Office, this change would generate $61 billion in savings over 10 years that will be used to boost Pell Grant scholarships, make student loans more manageable for borrowers to repay, and strengthen community colleges'
Thank you Carla. Great work.
Dogsinight, aka Dana, I could see somewhat your point, but it states that all Minority Serving Institutes will receive boost. and as pointed out above, save more money than it spends. Now, this is where i also get concerned. Promises are a lot easier to make than keep or prove, as the future will be the proof in every category of spend now, save later. Like Health Care. I would possibly vote for you just to get the old Reps out, but you need to make sure not to make a statement such as in #4 or #4.5 which come out kinda half-truthy. The Bill classifies ALL MSI's, which are already in place and assignable w/in legislation. But I truly believe there is consistency here for mixing Apples and Tomatoes in Bills that Obama leads(Bushbama is my pet name for him!) which he could have worked harder at eliminating. But that is the same BS in BOTH PARTIES and probably always will be. Too much like business as usual for me.
I hope the future proves us both wrong and this "hidden" item proves beneficial in retrospect, but I imagine you should find more salient issues to contest if you wish to even partially succeed in your quest for change. There are plenty of them on both tickets!
Good luck all, and thanks for caring enough to run for office to effect change, Dana, as action does speak louder than just words.
Peace to all.
Yes, I agree that the current healthcare system is not working at all. What the system needs in genuine reform, not Individual Mandates. Insurance companies want to pull my clients into the system to spread the cost around and to preserve their profit margins.
Here's my solution: 1)Eliminate price gouging and duplicate services. There is unbelievable waste in the current system. 2)Allow for Open Market and Fair pricing so that consumers can choose among several choices. Forget about state lines restrictions if you want to get costs down. 3)PREVENTION, first, then you can talk about how to cure the diabetes, arteriosclerosis, and other primarily preventable conditions that lead to a host of problems. 4)Declare war on Obesity since it causes many many problems including but not limited to heart attacks, diabetes, etc.
As an addendum to ur thought Don, I'd get rid of the requirement to get referred by ur primary doc to a specialist. For instance, I have congenital hydrocephalus (water on the brain). I know when my shunt is malfunctionin'. I should not have to go to my primary doc (who I only have been seen a few times in the last yr) to get to a neurosurgeon (who I have seen for over 20 yrs and who knows me *very* well).
But, ur thoughts r right on, Don...
Healthcare should not be a for profit industry. When the CEO of anthem is deciding if you get a heart transplant he shouldnt be looking at if that choice will eliminate or reduce his 17 million dollar bonus...
Until the GREED in the insurance industry is removed the cost of healthcare will spiral. HMO's are the real driving factor behind the rising costs. The cut reimbursment to providers, raise your premiums and then give themselves HUGE bonuses at the end of the year to congratulate themselves on how well they fleeced you.
The Government should have done something about medical cost instead of insurance.
Shawn:
That may have a very chillin' effect in stifflin' innovation and exploration. Then many *more* people would die:-(
HE did, there is a requirement that ins has to spend 80% of every premium dollar on healthcare instead of bonuses.... Guess the CEO of anthem (blue cross) will have to get a lesser bonus this year instead of 17 million....
There are a couple of problems with the 80% requirement
I agree the bill isnt perfect but its a start. But atleast the insurance companies will have to show they paid out to healthcare providers 80 cents of every dollar they take in which is more than they do now and those financial records will be audited yearly.
U have always had the right to appeal. That has not changed.
no actually you havent if you dont live in a state that has a law allowing it or were in an ERISA plan.
And appeal is a weak process in Health Insurance. All they have to do is say NO.
I have had experience this multiple times. Very frustrating and non=productive. One time I did get an MRI approved, but such BS back and forth to get them to do what was right.
Left alone, the system would collapse anyway. My wife and I each spent 3 days in the hospital being stabilized due to a vicious noro virus. Know what the bill was? Nearly $75,000. That's right, no surgery, just bed and tests. How could this possily go on?
I don't doubt your statement, but after spending a lifetime in health care system, I never heard or seen of a 3 days bill (for 2 patients) coming even close to that figure.
Really Antonio? How about one rotator cuff surgery with one day stay in a hospital for over $38,000? I can send you the medical bill if you want to pay them.
My doctor was upset because I was cooking and drinking the best antibiotic of this world: Hot chicken broth. I did not want to go to the hospital and get more germs, the pneumonia was plenty.
Antonio, you don't know much about hospitals. I hope it stays that way, but don't doubt what you don't know w/out research FYI.
Peace
About those increases in the cost of coverage: We buy insurance for our small company. Last year our health insurance premiums went up 28%, and the company we contract through (for this insurance) increased our administrative fees from $136 a month per employee, to $500 a month per employee. Seriously. And we got our notice for these changes exactly 30 days before the change went into effect, making it impossible to find alternative insurance coverage for our employees. At least now we have the option of using one of the plans available on the government's website. And yes, our health premiums will be going up this year, but we'll have a tax write-off to offset those increases, something we didn't have last year. While we're not THRILLED with the health insurance issue, we're in a heck of a lot better position AFTER "Obamacare" than we were before.
You know, reading these boards over the past few months, most of what I have seen is "Obamacare is going to hurt my business, I'm already cutting back..."
It is refreshing to see another point of view
Agreed, S_P!
Peace
I dont see how this is anything new, people have always been able to file appeals to denials by insurance companies. I've been helping my employee's do it for years, and we have a self-funded plan... this is nothing new...
not all plans allowed independent review, and some appeal rights were limited in states that didnt have laws to allow it or you were in an ERISA plan. Try getting ABA therapy covered without that level of appeal...
MSNBC needs to come up with some positive talking points, hence, the appeal. Every insurance company has an appeal process. It is not to say that their process is fair or patient friendly, but it's there.
To highlight the degree of incompetence of the "front" decision makers; When my wife broke her vertebrae (lower back), and required surgery, BC/BS denied the claim on the grounds that it was "cosmetic" and they didn't cover cosmetic surgery !!!!!
I had to go up to the senior VP to accentuate the degree of stupidity - those who get paid to make stupid decisions.
So, if you get denied, it's sometimes because the claims "examiner" has no clue what he/she is looking at. Appeal it vehemently and don't be too shy about it.
I hope Obama's Healthcare laws prove me wrong, but overall, I don't see things improving in time for the next Administraion/Congress to throw out the reforms(the Republicans, I mean of course) should they take back control(and I use the term 'control' loosely!)
I feel Bushbama, pardon my pet name, still has a long way to prove he is not another corporate schill puppet, as I was never caught up in the groundswell feelgood wave during his campaign. I just couldn't imagine the guaranteed-to-giveaway-the-whole-Bush/Cheney mess ticket of McCain/Palin being in the WH, and believe the Powers that Be didn't want them there.
If we get out of Iran/Afghanistan, clean up the Oil Regulators/Industry(including taxing the hell out of them), and stop being told half-truths on where our economy is at, for just a few, then I would be happy to eat crow. But for now, it looks like I'll be out of my house and on the street before anything changes.
Good luck, and God Bless America(as well as the rest of the World)
Unfortunately, it will take another generation or two before we have a one payer system. Obama has been brave enough to begin the overhaul of our health care system, but it is still run by the greedy partnership of private health care insurers and, of course, pharmaceuticals. These two unethical giants give big time bucks to equally unethical politicians to vote to keep 'the system' the way it is, which means screw the common man and keep on rolling in the dough.
How does a one-payer system help? Other than you don't have any options other than what the government tells you. It may work in much smaller economies with very different political systems like Britain or Canada, but it remains to be seen whether it would work here.
I'd much prefer an open system with options, especially if it was more market-driven with costs apparent up front - like health savings accounts.
These utopian dreams have a way of turning into nightmares. There is no free lunch (or healthcare) in this world. Maybe in the next.
Lets see now. Gov Healthcare? No child left behind? My wife has to pay over 8hundred a month for health Ins. I finally reached 65 cutting my high payments. But Bama is cutting medicare coverage to pay for his program. My grand daughter can not read and understand nor can she do simple math. But she passed each level and grade. (No child left behind) Sorry! But so far the only thing Bama and his bunch have done for me is donate 4500 dollars toward a car made in Japan. (his plan to help the economy) I never would have thought it possible but this administration is even worse than the one under Bush. (sic)
I couldn't go that far yet, and I am no big 'fan' of either. Still I like Obama quite a bit more as Pres than W.
I would have liked to do a line and drink w/ W back in the day, though! He seems like you would be kept laughing by most of what he said and did!!! But President?!?!
I am not sure if the insurance will pay for this surgery. My dr. said it was necessary as it casuse the organs to dye from lack of blood. So far they are tring to deny it. how do i get them to pay ....
anyone got ideas how to rectify this mess....