Does the new HCR address...?

Factual Questions
1

I’m all happy for you Americans with the success of the passing of the HCR bill.

congrats

but I have one question that doesn’t seem to come up, but still bothers me.

What about the guy who undergoes a treatment regimen only to find out that his insurance company won’t underwrite it ?

I’ve heard about this problem more than once.

Given that there are a whole lot of different insurance companies with different criteria for coverage, wouldn’t this still be a problem ?

Do Americans still have to consult with their insurance company to ensure that they are covered for any specific treatment ?

2

There’s a minimum set of requirements that insurers have to cover in all plans. There’s also a set standard of coverage that insurers have to offer to people on Medicaid, which is much higher than it is at the moment. There will also be much stricter limits on deductibles (the portion of any claim not covered by your insurer) and co-payments (an initial payment required before the insurer will cover you).

But insurers don’t have to cover everything, people would still have to check their plans to see what is covered and what isn’t, and deductibles and co-payments are still legal, they’re just more limited and regulated.

3

The Patient Protection and Affordable Care Act prohibits rescission except in cases of fraud, so if you get sick the insurance company can’t yank away your coverage, starting in September 2010. Nor will insurance companies be allowed to deny coverage based on pre-existing conditions, at least after 2014.

Also, there will be health insurance exchanges set up, which will aid in comparison shopping for individuals and small businesses, again in 2014. All this is assuming that Republicans don’t succeed in their stated goal of repealing health care reform.

4

Perhaps I’ve been misunderstood.

Will the hospitals still have to consult with the individual insurance companies plans to ensure coverage for specific operations or treatments ?

5

I believe you’re referring to pre-authorization and pre-certification, correct? I have nothing useful to add, other than that those specific terms might jog someone else’s memory.

6

Yes. Why wouldn’t they? People still have to buy private insurance plans from private insurance companies. Since 1988 emergency rooms have been required to provide stabilizing care for patients before they can even inquire about their insurance status, and the HCR legislation will enforce a minimum set of treatments and services that all insurance plans will be required to offer. But people won’t necessarily be covered for everything, it’ll depend on their plan.