Re: Watch out! Affordable Care Act plan excluding MPK's !
Matt Bailey
Description
Collection
Title:
Re: Watch out! Affordable Care Act plan excluding MPK's !
Creator:
Matt Bailey
Date:
3/27/2014
Text:
For clarification, I wasn't blaming this on the ACA; just cautioning that
the coverage still isn't universal.
Follow up to what I have found out so far.
1) Prosthetic parity is State by State. It is not regulated Federally even
with the Affordable Healthcare Act.
2) Some plans may still have exclusions (This Specific Blue Cross plan
excludes MPK's, another Blue cross plan does not). One down side is
that patients CANNOT switch plans until re-enrollment starting November
15th!!
I guess we need to find out which plans work best and advise our patients,
because it is not easy for them to find out. It isn't easy for the
insurance agent to find out about small exclusions either. So must be
really careful.
3) Since enrollment ends Monday (unless extended), we will have to research
these plans and advise people based on their specific need by November. The
problem is that NEXT YEARS PLANS MAY CHANGE BEFORE THEN.... ARG!!
On the upside, we have a lot of amputees in need getting coverage who
couldn't before.
The *BEWARE* part is that your patient must be careful to sign up for the
right plan, otherwise they may not get the prosthesis they need and they
can't change plans for a year.
I will post thoughtful replies without names unless asked not to :)
*Matt Bailey CPO, LPO*
*Fellow American Academy of Orthotists and Prosthetists*
*palmbeachprosthetics.com < <URL Redacted>>*
On Wed, Mar 26, 2014 at 12:13 PM, Matt Bailey < <Email Address Redacted>
> wrote:
> I have several patients that have signed up for ACA plans. So far, all
> Blue Cross plans.
>
> First patient was Trans-Tibial and went without a hitch.
>
> Have two trans-Femoral patients that went through Auth for MPK knee's and
> were denied because MPK's are *NOT A COVERED BENEFIT!*
>
> How is this possible with *prosthetic parity *that they can exclude
> MPK's?
>
>
>
>
> *Matt Bailey CPO, LPO*
> *Fellow American Academy of Orthotists and Prosthetists*
>
> *palmbeachprosthetics.com < <URL Redacted>>*
>
the coverage still isn't universal.
Follow up to what I have found out so far.
1) Prosthetic parity is State by State. It is not regulated Federally even
with the Affordable Healthcare Act.
2) Some plans may still have exclusions (This Specific Blue Cross plan
excludes MPK's, another Blue cross plan does not). One down side is
that patients CANNOT switch plans until re-enrollment starting November
15th!!
I guess we need to find out which plans work best and advise our patients,
because it is not easy for them to find out. It isn't easy for the
insurance agent to find out about small exclusions either. So must be
really careful.
3) Since enrollment ends Monday (unless extended), we will have to research
these plans and advise people based on their specific need by November. The
problem is that NEXT YEARS PLANS MAY CHANGE BEFORE THEN.... ARG!!
On the upside, we have a lot of amputees in need getting coverage who
couldn't before.
The *BEWARE* part is that your patient must be careful to sign up for the
right plan, otherwise they may not get the prosthesis they need and they
can't change plans for a year.
I will post thoughtful replies without names unless asked not to :)
*Matt Bailey CPO, LPO*
*Fellow American Academy of Orthotists and Prosthetists*
*palmbeachprosthetics.com < <URL Redacted>>*
On Wed, Mar 26, 2014 at 12:13 PM, Matt Bailey < <Email Address Redacted>
> wrote:
> I have several patients that have signed up for ACA plans. So far, all
> Blue Cross plans.
>
> First patient was Trans-Tibial and went without a hitch.
>
> Have two trans-Femoral patients that went through Auth for MPK knee's and
> were denied because MPK's are *NOT A COVERED BENEFIT!*
>
> How is this possible with *prosthetic parity *that they can exclude
> MPK's?
>
>
>
>
> *Matt Bailey CPO, LPO*
> *Fellow American Academy of Orthotists and Prosthetists*
>
> *palmbeachprosthetics.com < <URL Redacted>>*
>
Citation
Matt Bailey, “Re: Watch out! Affordable Care Act plan excluding MPK's !,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/236211.
