Wednesday, September 9, 2009

I can’t afford to wait: son with autism

Autism is a pre-existing condition – yes, autism! I heard a mother say that because she had three girls with autism they couldn’t get insurance. So, I was compelled to research it. And horrifyingly enough, I found out that it’s true. That slapped me in the face. If we lost our insurance, the insurance industry would deny my children coverage.

I really think that most people who oppose a public option don’t really understand what it is and how it can work. And I don’t think they’ve done any research into why and how it would improve health care for the rest of us. The Republicans have certainly been very effective in scaring everyone – even if they don’t really understand why they’re scared.

It reminds me of college. I wrote my senior paper on the Effects of Existentialism on the New Left. When I told a guy about my paper he told me that he was an existentialist. Shocked, I questioned him. “You don’t believe in God?” He told me he believed in some higher power, floating thing. “Then you’re not an existentialist.” I replied. Most people who don’t support a public option remind me of this guy. They’re not sure what it is but they know it’s bad.

Al Frankin makes more sense then most of these people.

Consider me holding a sign in solidarity, “I can’t afford to wait: son with autism.”


Anonymous said...

That is shocking, but NOT suprising!


Anonymous said...

So is being pregnant!

What is a pre-existing condition exclusion?

A pre-existing condition exclusion excludes coverage for a certain period of time for charges related to any medical condition or illness for which medical advice or treatment was recommended or received within a stated “look-back” period that precedes the effective date of coverage.

The usual pre-existing condition exclusion period excludes coverage for a one-year period after the effective date of coverage. The usual “look-back” period for identifying pre-existing conditions is usually one or five years before the effective date of coverage depending on the contract.


Life as the mother of 4 said...
This comment has been removed by the author.
Life as the mother of 4 said...

My comment didn't make sense so I rewrote it.

I was pregnant once without pregnancy coverage. My insurance paid for the baby once he was born and paid for parts of my hospital bill.

Insurers won't pay for a child with autism even to see their pediatrician for a well-visit if they are denied insurance coverage for having autism.

It's wrong, and immoral.

Anonymous said...

Title I of HIPAA regulates the availability and breadth of group health plans and certain individual health insurance policies. It amended the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code.
Title I also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits relating to preexisting conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment.[1] However, individuals may reduce this exclusion period if they had group health plan coverage or health insurance prior to enrolling in the plan. Title I allows individuals to reduce the exclusion period by the amount of time that they had "creditable coverage" prior to enrolling in the plan and after any "significant breaks" in coverage.[2] "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid.[3] A "significant break" in coverage is defined as any 63 day period without any creditable coverage.[4]
Some health care plans are exempted from Title I requirements, such as long-term health plans and limited-scope plans such as dental or vision plans that are offered separately from the general health plan. However, if such benefits are part of the general health plan, then HIPAA still applies to such benefits. For example, if the new plan offers dental benefits, then it must count creditable continuous coverage under the old health plan towards any of its exclusion periods for dental benefits.
However, an alternate method of calculating creditable continuous coverage is available to the health plan under Title I. That is, 5 categories of health coverage can be considered separately, including dental and vision coverage. Anything not under those 5 categories must use the general calculation (e.g., the beneficiary may be counted with 18 months of general coverage, but only 6 months of dental coverage, because the beneficiary did not have a general health plan that covered dental until 6 months prior to the application date). Unfortunately, since limited-coverage plans are exempt from HIPAA requirements, the odd case exists in which the applicant to a general group health plan cannot obtain certificates of creditable continuous coverage for independent limited-scope plans such as dental to apply towards exclusion periods of the new plan that does include those coverages.
Hidden exclusion periods are not valid under Title I (e.g., "The accident, to be covered, must have occurred while the beneficiary was covered under this exact same health insurance contract"). Such clauses must not be acted upon by the health plan and also must be re-written so that they comply with HIPAA.
To illustrate, suppose someone enrolls in a group health plan on January 1, 2006. This person had previously been insured from January 1, 2004 until February 1, 2005 and from August 1, 2005 until December 31, 2005. To determine how much coverage can be credited against the exclusion period in the new plan, start at the enrollment date and count backwards until you reach a significant break in coverage. So, the five months of coverage between August 1, 2005 and December 31, 2005 clearly counts against the exclusion period. But the period without insurance between February 1, 2005 and August 1, 2005 is greater than 63 days. Thus, this is a significant break in coverage, and any coverage prior to it cannot be deducted from the exclusion period. So, this person could deduct five months from his or her exclusion period, reducing the exclusion period to seven months. Hence, Title I requires that any preexisting condition begin to be covered on August 1, 2006.

Life as the mother of 4 said...

Are you arguing that it's ok for insurance companies to not cover the medical costs of people with autism for a certain period of time or are you arguing that it's ok to refuse to cover them at all?

I understand that we have different opinions over this -- after all it's my son that affected by this, thus my problem.

Anonymous said...

No! I'm saying:

[1] it is "standard practice" for many things to be treated as "pre-existing conditions."

[2 Existing law, protects people who already have insurance from loosing that coverage.

[3] Existing law limits the time period of a pre-existing condition.

HIPAA 1996

Life as the mother of 4 said...

But once they've lost coverage either by aging out of coverage under their parent's policy or due a break in group coverage they are usually denied when someone attempts to buy them private insurance.

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