Summary of results: Lifetime dollar limits and healthcare reform

Summary of results: Lifetime dollar limits and healthcare reform

William Lifford

9/30/2010

Hello colleagues,

Here is the summary of results to my post of last week. I received four
replies, all of which were interesting, but none had an absolute answer
to the original question. It seems like we are just going to find out
as we go along.

Thanks to all,

Bill Lifford, CP
Progressive O&P, Inc., Carle Place, NY
Prosthetic Appeals Specialists (www.prostheticappeals.com)

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Here are the replies I received:

1. Just a suggestion, maybe go back to CNN Money and ask them for
their source. They usually publish with credible sources. I belong to
MGMA(Medcial Group Managment Association) and ACHE(American
College of Healthcare Executives) I will see if anyone on their listserv
knows anything.
Lisa Smith
Director of Ops
Westcoast Brace and Limb


2. Quick note: California passed Assembly Bill 2012 that eliminated
any of the historical limits on prosthetics and orthotics and mandated
that they be subject to the same limits of the rest of the medical policy.
Regards,
Tom Cutler, CPO, FAAOP

3. I don't know what you consider inflammatory, but all the
healthcare changes were put into the 2008 stimulus bill and we are not
allowed to look at it. Only parts are leaked, so what you are reading
is probably planned disinformation, like any political public control.
  Best,
Kenneth


4. From what I understand on some of what goes into effect TODAY is this:
      Pre-existing conditions benefits and coverage for
children.....that sounds great, BUT the catch is that it must be a NEW
policy and have ALL the family included as a new policy. Many of these
cases is that a parent is working and HAS benefits from the employer for
himself/herself...but cannot afford to add a child with expensive
medical conditions. So, to get this NEW benefit, the parent would have
to now have an entire FAMILY policy, costing at least $1000 a month for
that coverage. Most cannot afford such a policy. In my case, I have an
adopted son from China who is missing his right hand...and since parity
passed here in Indiana, he now is not able to get covered on a policy
because he has a pre-existing condition. I am also an amputee, BK for
12 years, and since parity passed, I cannot get a new policy either,
since I have a pre-existing condition. SO, I cannot get my own son on a
policy today with HIS situation, because I cannot get coverage myself.
This was a great loophole that was left in the bill which helps protect
companies like Anthem, so they don't have to take on these losses of
having sick children and the expensive treatments.
      Next, the lifetime limits is also only applicable to NEW
policies, which must take effect today. The insurance companies are
going to be very selective on WHO they will accept on a new policy
like this.
     As far as applying to O&P....well, the bill totally eliminates
coverage and doesn't even mention O&P as a medically necessary service
or device. It WAS in the House bill as being necessary....BUT the
Senate version totally excluded the mention of O&P and was intentionally
ommitted from any kind of Healthcare benefits. And, to make that even
worse, there is the new medical device sales tax of 2.9% that now has to
be paid for any medical device, including O&P....called the Medical
Device Sales Tax for all medical devices.
      So, is this healthcare reform any good for this profession or the
amputees that NEED prosthetics?? I personally don't think so. As an
amputee, and parent of a child with prosthetic needs....this bill is NOT
a good thing at all.
      And, to kind of give you an idea of how this all happened....Max
Baucus is the author of this bill, starting as the Senate Finance
Committee chair and writing the Senate verson of the healthcare bill.
He was asked last week if he even read the bill, and he chuckled and
said, Of Course NOT, he claims to have a good staff that wrote it, and
who read parts of it and explained some of it to him...but he never even
read it.
     Google who his staff is, and especially the Chief of Staff.....Liz
Fowler....and then look up her resume...she just happens (or happened)
to be the Vice Pres of External Affairs for Anthem/Wellpoint/Blue Cross
Blue Shield. SHE WROTE THIS BILL, and so of course it will NEVER allow
any financial damages to occur to Anthem.
      And with her writing this bill, forcing everyone to have
insurance....Tom Daschle, the Czar of the Healthcare Reform, was in the
White House pushing this, and also working with his friends in
congress and the senate, while also working as the chief lobbyist for
Anthem. Google that as well, Tom Daschle, lobbyist, Anthem, Czar,
etc....and you will see what I am talking about.
      This bill is terrible, and thank heavens the MAJORITY of the US
realizes how bad this is. Hopefully this will be a top issue in the
November election. We need a DIFFERENT approach to this reform, and
different ideas on how to change some of the problems we
face...especially when it comes to making prosthetic limbs for people.
I rarely have a smooth or easy time billing and getting paid for any
prosthesis when an insurance company is involved. Medicare hasn't
caused me any grief...(yet), and Medicaid in Indiana has been simple and
really great to work with. But ANthem....well...that's another LONG
story of many examples of how greedy and horrible they are to work
with...or against is a better way to say it.
      Thanks for posting this question and comment on these new policies
that go into effect today.
      Paul will never post anything I write anymore it seems. I am not
sure if that is intentional, because of my political stand on things, or
what. But, just so you know, the leaders of the Academy as well as AOPA
are big Obama supporters, and also used money from the organizations to
donate to his campaign.....and so I am no longer a member of either
organization. NAAOP is also huge with Obama and the far left wing of
politics....George Breece, the founder and director, is on the
Huffington post oni how much he supported Obama. They all have their
own right to support whomever they want to, BUT there are consequences
to those choices, especially when you do things representing the
organization where most of the members do NOT support the campaign or
what they are pushing...like Healthcare reform that doesn't even now
consider O&P as medically necessary. That is NOT a smart move on their
parts in my opinion.
Anyway, I just want to share this, for what it is worth.
Take care,
Jim DeWees, CP