March 20, 2010

Will the New Health Insurance Bill be a Cure or Just a Bandaid?

Posted in Uncategorized tagged , , , , , , , , , at 1:48 am by keepyourhearthealthy

I was realizing today that much of the health insurance process is elusive and frustrating to the average patient.  A family member called me to complain about a claim that had been denied for her due to a mere suspicion of a “pre-existing condition.”  Healthcare reform is a hot topic on every news channel this past week.  If the President’s bill passes, supposedly my family member’s problem will go away given that the bill will not allow health insurance companies to deny claims for “pre-existing conditions.”  Clearly that would be an ideal situation for many Americans!  However, I can’t help but wonder if the health insurance companies may be able to find a loophole.  They are already so good at finding any excuse to avoid paying for all of our health expenses!  I am afraid they might find it a little too easy to work around all the legal jargon in the bill.  They probably have staff already prepared and committed to working full-time on finding the loopholes for the new healthcare bill!

For instance, let me explain one of the multiple loopholes the insurance companies have already found for the existing laws and guidelines (yes, there are some that have been around awhile!).  When I was 32 weeks pregnant, my husband’s company changed health insurance plans.  The new plan would pay 90% of our expenses if I switched to a different Obstetrician who would deliver at a further away hospital.  An existing law states that health insurance companies must pay for a pregnant woman’s current doctor and hospital since most Obstetrician’s will not accept a new pregnant patient past a certain point in the pregnancy.  I attempted to switch doctors anyway and was told I could not be accepted by the preferred physician practice.  I applied for “Continuing Coverage” as stated by the law in order to get full insurance benefits with my current doctor.  However, the new health insurance plan will not agree to pay the 90% because they said my previous doctor was still considered “in-network.”  They have agreed to pay 70% of the bills which has left me with the full $5,000 worth of out-of-pocket expenses to pay!

The moral of my long-winded story is this: despite the law which was designed to force insurance companies to pay for a pregnant woman’s delivery fees, the companies have found a way to avoid paying the full amount expected!  Will this new health care bill truly be the saving grace for everyone or will it just give the health insurance companies a few speed bumps?  Apparently we will all just have to wait and see…

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