Understanding the new affordable health care act


A new poll from the Kaiser Family Foundation shows that the country is still confused by what the new Affordable Health Care Act does and does not offer. According to the Kaiser poll, 6 in 10 Americans view favorably the provision that requires insurnce companies to provide easily read and easy-to-understand benefit summaries. Take a minute to think about this. First, the fact that you have to put into law that insurance companies have to make clear what they are offering sure doesn't say much about the ethics of insurance companies. I know, I know, you all want to know what rock I have been living under. What I read in this mandate is that most people don't have a clue what their insurance will or will not cover -- because the insurance company made it that way intentionally. How do these people sleep at night. In the one woman show I do called One Mutant Cell, I joke about being denied coverage for a wig because I filed a claim for the wrong thing. Where, I ask you, would I have run into the information that in insurance language a wig is a "cranial prosthesis" -- and that is what I was supposed to file for. Then when I got the reimbursement, it was much less than I expected - of course. I called the insurance company and was given the formula they use to figure out what they will pay. OK folks, math was never my strong suit, which is why I am a journalist. My trade is in words. But the forumula they gave me was so complicated it took me an hour to figure it out. The big kicker was one sentence that was something like this:"policy pays xxxx percentage of usual and customary costs." Ok, so what are usual and customary costs for a wig. Well, come to find out that those numbers are on a document hidden in a vault somehere in insurance land. No kidding. They wouldn't give me the figure. I learned a lot about insurance policies the year before I got cancer when I gave birth to a premature baby. I had never filled out an insurance claim until my daughter was born, and then I got to be an expert. What I learned was that my insurance policy was written in a way that I couldn't possibly know how much was not covered because I had not yet encountered the situation so didn't understand what I should ask. This is where they get us -- they research what we will need and figure out how not to pay for it and sell us on all the pretty wrappings. It's like taking a bite of a beautifully decorated cake to find cardboard underneath. When it came time to take my daughter home from the hospital I had to put the bill on a credit card -- $10,000 -- in 1985. It took years to pay off. So that resulted in me learning how to read an insurance policy, and, since my husband was self employed, I went out and compared and found one that was $1,000 out of pocket and then they paid 100%. I signed us up -- then a month later I was diagnosed with breast cancer. Sorry. I was well covered for my cancer, but when it came time to renew my policy the next year, the rates quadrupled. This was where they got you. I called and got the gobbleydgook about why before letting it lapse. I had taken a full time job and the insurance kicked in the day after the policy ended. I was very lucky. Today cancer patients face bankruptcy in numbersyou won't believe -- and this is when they have insurance. Check out the story in our winter issue on financial toxicity.This brings me to a question. Is there a good insurance company out there that has made it easy to file and that has been supportive and clear about what they and do and do not cover. Which one is it? Tell us please. We want to thank them.

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