It is common to either not know or forget the Affordable Care Act (ACA) is the shortened name for the Patient Protection and Affordable Care Act signed into law on March 23, 2010. Lest anyone believe the full name of the law is a misnomer, a few of the key patient protective aspects of the law are worth reviewing and understanding.
Essentially the most heralded and conspicuous patient-protection provision from the ACC is the abolition in the pre-existing-condition concept which insurance providers have tried as a pretext to deny, exclude, cancel, or inflate coverage. It has long been the financial Achilles’ heel of numerous individuals and families, but it will discover its total demise by virtue of Obamacare since January 1, 2014. The very first deathblow was delivered using the passage from the law on March 23, 2010 which, beginning on September 23, 2010, prohibited insurance companies from denying or excluding coverage of children under 19 due to pre-existing conditions in every individual policies except the ones that are grandfathered or were purchased before March 23, 2010.
A related provision in the law which has received significantly less press and fanfare is the prohibiting of insurance companies from canceling coverage due to honest application mistakes. This change is similar to the days when almost immediately after submitting claims for services provided to an alternative patient I might receive a request old records through the insurance company, simply to later discover that they were denying payment from the claim based upon a pre-existing illness. The decision would be the reaction to a self-serving conclusion on the portion of the insurance company responding to a question or questions on the application in which the patient had answered “no” to, regarding having ever experienced signs and symptoms of certain disease(s). After reviewing the medical history and physical which I submitted, the insurance carrier then assumed that based on documented signs or symptoms in the report, the patient obviously had the condition before the date of coverage, if in fact it could not really proven, nor did the patient even know those symptoms can be linked to the condition(s) that coverage was denied.
Another major part of patient protection afforded from the ACA is really a limit on patients’ cost-sharing responsibility, referred to as annual out-of-pocket expenses, or perhaps the amount that patients need to pay for covered services and drugs in a calendar year before the insurance company picks up 100% in the charges. Out-of-pocket pricing is generally perceived to be copayments, deductibles, coinsurance, or a mix of either, however some companies down over the years have excluded deductibles, that have increased out-of-pocket costs considerably. That practice will no longer be permitted, starting in January 2014 as a result of Affordable Care Act. The limit on out-of-pocket expenses for many healthcare plans sold in the usa starting in 2014 will be $6350. Additionally, individuals whose incomes fall in the 100% to 200% of the federal poverty levels and the ones whose incomes are between 200% and 250% in the federal poverty level will have reduced annual cost-sharing responsibilities of $2225 and $5200 respectively beginning in 2014. Grandfathered plans, which can be people who were around before March 23, 2010, and which may have not substantially reduced benefits or raised premiums, are exempt from patient cost-sharing limits however.
The imposition of lifetime and annual dollar limits on covered benefits by insurance firms continues to be detrimental to a lot of patients in the past, leaving many in positions of bankruptcy because of spiraling healthcare costs no longer covered by their policies. The Affordable Care Act made it illegal however, for insurance firms to permanently stop paying for most covered services simply because they had reached their spending limit for a policyholder. That aspect of the law took effect on September 23, 2010. The ACC currently limits the annual spending restriction that some companies still impose, and can eliminate the limit altogether beginning in 2014.
The Patient Protection and Affordable Care Act makes it mandatory that health plans provide certain categorized basic coverage also referred to as essential health benefits. Those include outpatient services such as doctor visits, emergency services, laboratory testing services, mental health services, substance abuse treatment, maternity and newborn services, prescription rocero coverage, rehabilitation, pediatric services and a few preventive and wellness services. The law specifies that this preventive services should be free from charge and not susceptible to copayments, deductibles or coinsurance.
Because of the complexity of health insurance, the meager health and health-insurance literacy of the population in general, as well as the unscrupulous precedent set by many people within the insurance industry, some of the provisions inside the Patient Protection and Affordable Care Act really are a breath of fresh air to numerous.