Simplifying Obamacare (Continued)
Consumer protections — taming a wild horse
The patriotically named Patient's Bill of Rights is the heart of the ACA's consumer protections and mandated reforms of the health insurance marketplace. It bans out-right pre-existing condition denials for children under age 19, a blessing to parents of type 1 children; lets parents keep their children on the family health plan until the age of 26; and protects your right to choose your doctor.
In the future, out-of-network emergency room visits will have to be covered. It's crazy, I know, but many people don't have this now. So don't step in front of a bus in a strange city for a few more years.
The ACA sets aside Federal dollars to help states create Consumer Assistance Programs that will serve as "go-to" bodies to help you in the inevitable fights with your health plan. They'll help you file complaints and appeals. The ACA also expands your ability to appeal a refusal of coverage, including the right to an external review.
And already up-and-running, the law has set up a bridge plan that covers Americans with pre-existing conditions until 2014, when the ACA will bar all insurance plans from turning away people with pre-existing conditions, like diabetes.
Food labels for health plans?
One rarely discussed change the ACA brings to the insurance marketplace is the Summary of Benefits and Coverage (SBC) document. The law requires all health insurance companies to give you cliffs notes on what's covered by a plan using a standardized format and a plain English "uniform glossary." No more Athabascan, Coptic Greek, or Swahili. This will help you when comparison-shopping for insurance plans.
Interestingly, the Nutrition Facts label on packaged food served as the blueprint for the new SBCs, which kick off in September of 2012. By law, SBCs must also include two "coverage examples" showing how a plan covers two real world health issues. For the two "common medical situations" the ACA chose the normal delivery of a baby, and the services to help a person control type 2 diabetes.
Wow. Birth and diabetes. There you have it.
So as a person with diabetes, you're directly written into the ACA in a very useful manner. Soon, when you're shopping for health insurance (if you have type 2), you can directly and easily compare how various plans will help you!
Wanna see what it will look like? Go here. It's a little bigger than the Nutrition Facts label that gave birth to it, but health plans are more complicated than a bag of peanuts. Be sure to scroll down to page 7 to see the type 2 diabetes "Nutrition Facts." In this example you"ll see that the health plan would leave you holding the bag on about a third of your total diabetes care costs.
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Years before I was diagnosed with type 2 diabetes, The Other Half came out of a doctor's appointment with a diagnosis of "borderline diabetes" and an ADA exchange diet sheet. His health insurance agency followed up on the diagnosis with a glucometer and test strips. After a year or so of trying to follow the diet plan and test his glucose levels, things appeared to be back in "normal" range, and stood there until a couple of years after my own diagnosis. Shortly...