Having health insurance doesn't necessarily mean that you are covered

[Hugabear]

Many insurance policies - especially those that one might get from their employer - routinely refuse to cover various types of visits and procedures. Or if they do, they may set your deductible so high, that you're still paying quite a bit out of pocket. For example - this year, I went for a routine physical, and then wound up paying nearly $2000 out of pocket because of various procedures the doctor ordered as a result.

The right-wing loves to talk about government "death panels" making decisions regarding your health care. What they don't tell you is that insurance companies already do this every single day.

While I'm glad to see that more Americans will have access to healthcare. My only concern - given the nature of for-profit insurance companies - is what kind of quality will that healthcare be?

[LiberalFighter]

1. Insurance companies have their own death panels.

They are the people that decide whether a claim is valid or will be denied. And it is very difficult for most to challenge denials.

[unblock]

3. oh, but they're PRIVATE death panels.

it's only PUBLIC death panels that are eeevil.
ask any right-wingnut.

[unblock]

2. yup. my high premium, high-deductible plan won't even give me enough migraine meds.

they cap me out at 6 zomigs per month -- 12 if i get my doctor to send in a "letter of medical necessity" (as if a prescription itself wasn't a letter of medical necessity).

i get 200-250 migraines per year, so 12 a month doesn't cut it. i have to use stadol (which i have to dilute to make it last the month) if i run out of zomig or just suffer.

[FedUpWithIt All]

4. I ended up with some difficult debt. after a miscarriage at 13 weeks.

Our coverage apparently did not include any of the u/s or blood tests or the clinic visits with the OB because there was an issue with the pregnancy from the start. We had a $6000 deductible and were paying a high monthly rate for the insurance.

Due to the timing of the miscarriage (Oct. to Feb.)we ended up $11,000 in debt.

[Fumesucker]

5. Forget it Hugabear, it's DU..

The clue train isn't stopping here any time soon, far too many of us are still on an adrenaline high from the gigantic liberal progressive Democratic win that just happens to be a Heritage Foundation project.

[Lex]

6. My wingnut aunt had this happen recently and blamed it on "Obamacare"

but I told her THIS kind of thing has been in place for YEARS.

[Poll_Blind]

7. That's the part that most people here seem to be skipping over.

I don't get it either. People will start figuring it out soon enough. Sometimes, that's all you can do to help a person: Give them time to see for themselves.

PB

[frazzled]

8. But most good employer plans do

Someone asked this question in another thread, and there are detailed, real-life experiences in the replies (not vague, undocumented generalities)
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=878001

There is also shitty insurance, mostly from shitty employers, but much more so on the private market. (Large pool) employer insurance otherwise is usually pretty good. But let's be clear: poll after poll over the years has shown that most people like their employer-based insurance. That is the reason why the health care bill ended up as it did: people DON'T WANT to give up their insurance. Don't blame me for that. I didn't make it up. It means that people are going to have to be weaned off their private insurance over time ... and this bill will accomplish that over the next decades.

Furthermore, you show ignorance of what the bill contains: there are many new regulations on insurers. They will have to cover more stuff; they will have to spend certain amounts of their premiums or give it back ($1.1 billion in checks are being prepared to be returned to employers and citizens right now); to be on the exchanges they will have to meet minimum standards--just like the insurance that Congresspeople get.

You know what? The time to argue this law is over. It's the law, and it isn't even fully implemented until 2014. Once it is in place and you see how it works, you can lobby for improvements. In the meantime, you're just barking with the Republicans, and trying to reargue what is already done.

[pnwmom]

9. The law requires that certain basic benefits be covered, and also should mean

that you'll have access to a variety of plans with different deductibles and coverage -- including non-profit health insurance.

[FarCenter]

10. Nor does it mean any given provider will accept your insurance.