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pnwmom

(110,326 posts)
32. I am very sorry about what happened to your wife. The ACA was written to try to prevent
Thu Sep 26, 2013, 02:54 AM
Sep 2013

the kind of thing that happened to your family.

A couple with an income of $40K a year will receive subsidies helping to pay for health insurance, and claims that are denied can now be appealed.

http://www.drsforamerica.org/blog/aca-power-to-appeal-when-insurance-companies-deny-claims


One of the most disheartening things I’ve witnessed as a physician is insurance denials of needed medical services in the name of saving costs or the desire not to pay for services. Well, all of that has now changed based on the Affordable Care Act. If you purchase a health plan on or after March 23, 2010, you have the right to appeal a health insurance plan’s decision. According to HealthCare.Gov, if your plan denies payment after considering your appeal, the new health law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. If your plan denies a claim, it’s obligated to:

-Provide the reason for the denial

-Inform you of your right to appeal

-Provide appeal information in your native language (if it's not English) if the plan begins on or after January 1, 2012

-Give you their decision within 72 hours after receiving your request when you're appealing the denial of a claim for urgent care

-Give you their decision within 30 days for denials of non-urgent care that you have not yet received

-Make a decision within 60 days for denials of services you have already received

-If, after an internal appeal the plan still denies your request for payment or services, you can ask for an independent external review. If your state has a Consumer Assistance Program, that program can help you with this request

-If the external reviewer overturns your insurer's denial, your insurer must give you the payments or services you requested in your claim

Although there are many benefits associated with the Affordable Care Act, the right to appeal a decision made by an insurer is empowering. You are no longer alone. You no longer feel helpless as I did when my insurer denied reimbursement for medical equipment that was mandated by my surgeon. I had attempted to complain to my Insurance Commissioner for assistance to no avail. Martin Luther King once said "Of all forms of inequality, injustice in healthcare is the most shocking and inhumane." The Affordable Care Act strives to bring these injustices to an end.



Recommendations

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I'm sure they'll find something else. RC Sep 2013 #1
Why? None of that would matter because preexisting conditions can't be excluded anymore.n/t pnwmom Sep 2013 #2
What about existing conditions? RC Sep 2013 #3
Because of the ACA customers who get screwed can switch to a competetor who covers it. tridim Sep 2013 #5
No health conditions can be excluded, whether current or preexisting. pnwmom Sep 2013 #6
Doesn't make any difference what they find - Ms. Toad Sep 2013 #10
The pre-existing changes alone are a big deal in many ways. Hoyt Sep 2013 #4
They don't care as much as you think because they get to way overcharge for covering such people. Dragonfli Sep 2013 #8
No, you're wrong. They do NOT get to charge more for preexisting conditions. pnwmom Sep 2013 #11
I apologize, for some reason I thought we all went into a special risk pool, I guess I was mistaken. Dragonfli Sep 2013 #15
We old farts (pre Medicare, that is) actually benefit the most pnwmom Sep 2013 #25
The unnecessary and vampirific nature of the very existence of insurance middle men Dragonfli Sep 2013 #18
Sorry to have offended you. But it was hard for me to believe a smart person pnwmom Sep 2013 #26
There will be increased premiums for pre-existing, there has to be, Nuclear Unicorn Sep 2013 #47
There will not be increased premiums for people with preexisting conditions. pnwmom Sep 2013 #49
I didn't say higher costs would be confined to patients with pre-existing condition Nuclear Unicorn Sep 2013 #53
Everyone else will NOT be paying a higher premium. pnwmom Sep 2013 #55
"By pulling more people into the system through the individual mandate" Nuclear Unicorn Sep 2013 #56
You said all premiums are going to be higher, and that's false. pnwmom Sep 2013 #59
No they don't. Ms. Toad Sep 2013 #12
That is good news, I am happy to hear your daughter can get a break. Dragonfli Sep 2013 #21
I am very sorry about what happened to your wife. The ACA was written to try to prevent pnwmom Sep 2013 #32
You appear to be missing the point, we were well insured, Insurance care is very expensive to USE, Dragonfli Sep 2013 #43
I think you missed my point. An insurer won't be able to string a patient along for 9 months pnwmom Sep 2013 #45
You know I am too angry to continue here, stop pretending the evil was vanquished, Dragonfli Sep 2013 #50
I didn't say "evil was vanquished," I said that the ACA is trying to fix the problem. pnwmom Sep 2013 #52
She has been relying on insurance companies to treat two serious, life threatening illnesses Ms. Toad Sep 2013 #40
My income was 40,000, and I don't have any income now. Dragonfli Sep 2013 #46
There is a difference between denying the vampire in the room Ms. Toad Sep 2013 #63
I am sick to death that no one cares to end the suffering Dragonfli Sep 2013 #64
I am not willing to allow everyone to continue to drown Ms. Toad Sep 2013 #65
I'm SO glad for you. pnwmom Sep 2013 #28
It is a relief - Ms. Toad Sep 2013 #41
Thank you, ErikJ! Cha Sep 2013 #7
YW Cha! ErikJ Sep 2013 #19
You do know area51 Sep 2013 #9
Cite, please. Ms. Toad Sep 2013 #13
I do know that investigating providers for fraud is a definite cost-saving measure... Hekate Sep 2013 #36
LOL! OnyxCollie Sep 2013 #14
From what I understand your rate is based on only 3 things ErikJ Sep 2013 #17
Exactly. And women can't be charged more. SunSeeker Sep 2013 #20
Message auto-removed Name removed Sep 2013 #16
Actually, the NYCLU didn't say that. SunSeeker Sep 2013 #22
+1 uponit7771 Sep 2013 #23
Message auto-removed Name removed Sep 2013 #24
Obamacare is not a Bush policy. SunSeeker Sep 2013 #27
Message auto-removed Name removed Sep 2013 #30
i see you joined DU tonight to push a bullshit right wing blog. nt SunSeeker Sep 2013 #31
Libertarians are anarchists for the rich/corporatists as they say. ErikJ Sep 2013 #34
Sadly, Libertarians prove you can smoke pot and still be an asshole. nt SunSeeker Sep 2013 #58
It's a Heritage Foundation plan solarhydrocan Sep 2013 #35
Heritage claims the mandate part. But not the other key parts (expansion of Medicaid, etc.). SunSeeker Sep 2013 #44
Alerted on our newbie friend and got a reply faster than light: 3/3 to leave it. Hekate Sep 2013 #37
Ha! Apparently an alerter with more clout or a different jury took another look... Hekate Sep 2013 #39
Me too. Whoever alerted first got a crap jury, but MIR noticed the repeated alerts. SunSeeker Sep 2013 #62
We are too fixated on health insurance and not health care... Spitfire of ATJ Sep 2013 #29
Hopefully a public option/single payer will be added somehow in the future. ErikJ Sep 2013 #33
The goal is free health care as a benefit for being a citizen of the richest cou,...wait a sec.... Spitfire of ATJ Sep 2013 #38
BINGO! nt adirondacker Sep 2013 #54
Who could not click on a thread title like that one? LWolf Sep 2013 #42
That's not entirely accurate OhioChick Sep 2013 #48
thanks for that. We need answers as to where the work is being done and what our antigop Sep 2013 #51
So, in other words... ChromeFoundry Sep 2013 #57
Message auto-removed Name removed Sep 2013 #60
Wondering if the internet connection is secure since most public ones are not. uppityperson Sep 2013 #61
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