O&P Business News Article, Regarding Pre-existing conditions

O&P Business News Article, Regarding Pre-existing conditions

Jim DeWees

9/17/2012

Hello all, Thanks for the emails and replies to my post last week. This morning, I need to post a REAL answer and point out that what many are stating as a positive part of the Affordable Care Act is not actually true. The O&P Business news article is full of misrepresentations about the ACA and how it will affect O&P. All you need to do is go to the AOPA website and read about recent lobbying efforts to get O&P mentioned as covered provisions under the Obamacare and the Essential Healthcare Benefits. The most recent articles on their website still show they are no successful at getting anywhere with this effort, so as it stands, O&P is NOT covered. So no matter how good any of these other issues MIGHT be in the ACA, if O&P is not covered, it is of no value at all. But, even if O&P makes its way onto the covered list of benefits, the one issue that the Business News states in big bold RED letters is that Currently, insurance companies cannot impose pre-existing exclusions on children. I would like to know from others on this listserve if they have any first hand experience where this is not true. I have personal, 100% REAL experience regarding this issue. I also have several patients that are in the same situation, where they are NOT able to get insurance benefits. This part of Obamacare went into effect over a year ago. I currently have an family policy, which is NOT part of a business group policy, but my own independent policy, and I am not happy with it and know there are better policies out there. BUT since the passing of the Parity Legislation in Indiana, I cannot find any insurance company that will now provide benefits for amputees. (For 13 years I was able to change companies or policies whenever I saw something better come along, but now they all ask about amputations and prosthetics....In fact, the NFIB insurance company, Assurant, has a list of states where they will NOT provide policies for amputees, which are the same states that have parity bills passed). My son, who I adopted from China, and has a limb difference, has also be denied by every insurance company due to his missing hand. Both of us are extremely healthy, take no medications on a regular basis, no cancer risks, surgeries, or anything. The only thing that is in our way of health insurance (being able to switch to another company with a better network) is that we are missing limbs (I am a BK amputee). When this part of Obamacare went into effect last year, I thought I would give it another try and went to a broker next door and after a few weeks, we learned that my son still can NOT get insurance with any other company. They will ONLY take on the child IF the entire family has a policy. AND since they won't take me because of my pre-existing issue, they will NOT take my son on his own. This is the same answer and response we got across the board. So, the out that these insurance companies have to use and play this game is that they will find something with a parent that will exclude them, and then since the family cannot have the policy, then the child with a condition can't get coverage either.
The other out the insurance companies have is about pricing. There is NOTHING that says anything about price controls and these children. Even IF they accept some child with pre-existing conditions, there is no price control on these, and they can price these to a point where the families cannot afford to pay to premiums. This is just ONE of many flaws in this article, which paints the ACA as a good thing for O&P. I strongly disagree, and we all need to wake up, check out what is going on, and do our jobs to get this situation changed, in whatever manner we can. I am really puzzled by how anyone in this profession can believe and publish any article stating that this is good for O&P. Thanks Jim DeWees, CP