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Thursday, July 1, 2010

Have a medical problem? Now you can be insured

This news release came out today from the Department of Health and Human Services. It will cover the uninsured who are without coverage due to a pre-existing condition.

News Release


FOR IMMEDIATE RELEASE

Thursday, July 1, 2010

HHS Secretary Sebelius Announces New Pre-Existing Condition Insurance Plan

Affordable Care Act Program to Provide Temporary Coveragefor Americans Without Insurance Due to Pre-Existing ConditionsNow Through 2014 When the New Insurance Exchanges Are Established

The U.S. Department of Health and Human Services (HHS) announced today the establishment of a new Pre-existing Condition Insurance Plan (PCIP) that will offer coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition.

The Pre-Existing Condition Insurance Plan, which will be administered either by a state or by the Department of Health and Human Services, will provide a new health coverage option for Americans who have been uninsured for at least six months, have been unable to get health coverage because of a health condition, and are a U.S. citizen or are residing in the United States legally.

Created under the Affordable Care Act, the Pre-Existing Condition Insurance Plan is a transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions, and individuals and small businesses will have access to more affordable private insurance choices through new competitive Exchanges. In 2014, Members of Congress will also purchase their insurance through Exchanges.

“For too long, Americans with pre-existing conditions have been locked out of our health insurance market,” said Secretary Kathleen Sebelius. “Today, the Pre-Existing Condition Insurance Plan gives them a new option – the same insurance coverage as a healthy individual if they’ve been uninsured for at least six months because of a medical condition. This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014.”

The Affordable Care Act provides $5 billion in federal funding to support Pre-Existing Condition Insurance Plans in every state. Some states have requested that the U.S. Department of Health and Human Services run their Pre-Existing Condition Insurance Plan. Other states have requested that they run the program themselves. For more information about how the plan is being administered where you live, please visit HHS’ new consumer website, www.HealthCare.gov.

“Health coverage for Americans with pre-existing conditions has historically been unobtainable or failed to cover the very conditions for which they need medical care,” said Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight (OCIIO) which is overseeing the program. “The Pre-Existing Condition Insurance Plan is designed to address these challenges by offering comprehensive coverage at a reasonable cost. We modeled the program on the highly successful Children’s Health Insurance Program, also known as CHIP, so states would have maximum flexibility to meet the needs of their citizens.”

In order to give states the flexibility to best meet their needs, HHS provided states with the option of running the Pre-Existing Condition Insurance Plan themselves or having HHS run the plan. Twenty-one states have elected to have HHS administer the plans, while 29 states and the District of Columbia have chosen to run their own programs.

Starting today, the national Pre-Existing Condition Insurance Plan will be open to applicants in the 21 states where HHS is operating the program.

All states which are operating their own Pre-Existing Condition Insurance Plans will begin enrollment by the end of the summer, with many beginning enrollment today.

“The Pre-Existing Condition Insurance Plan is an important next step in the overall implementation of the Affordable Care Act,” said Richard Popper, Director of Insurance Programs at OCIIO. “We have been working closely with the states and other stakeholders to make sure this program reaches uninsured Americans struggling to find coverage due to a pre-existing condition.”

The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. The Pre-Existing Condition Insurance Plan does not base eligibility on income and does not charge a higher premium because of a medical condition. Participants will pay a premium that is not more than the standard individual health insurance premium in their state for insurance that covers major medical and prescription drug expenses with some cost-sharing.

Like the popular Children’s Health Insurance Program (CHIP), the Pre-Existing Condition Plan provides states flexibility in how they run their program as long as basic requirements are met. Federal law establishes general eligibility, but state programs can vary on cost, benefits, and determination of pre-existing condition. Funding for states is based on the same allocation formula as CHIP, and it will be reallocated if unspent by the states. Unlike CHIP, there is no state matching requirement and the federal government will cover the entire cost of the Pre-Existing Condition Plan. While it took more than 6 months for a small number of states to establish their CHIP programs, we anticipate that every state will begin enrolling individuals in the Pre-Existing Condition Plan by the end of August.

Information on how to apply for the Pre-Existing Condition Insurance Plan is available at www.HealthCare.gov. Americans who live in a state where the U.S. Department of Health and Human Services is running the Pre-Existing Condition Plan will be linked directly to the federal application page. Those living in states running their own programs will also find information on how and where to apply on www.HealthCare.gov.

To learn more about the Pre-Existing Condition Insurance Plan and options available to residents of your state, visit www.HealthCare.gov.

An informational pamphlet on the Pre-Existing Condition Insurance Plan can be found at: http://www.healthcare.gov/center/brochures/pcip.pdf.

States by Pre-Existing Insurance Plan Administration

29 states plus the District of Columbia have chosen to operate their own plans.

Alaska, Arkansas, California, Colorado, Connecticut, District of Columbia, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, West Virginia and Wisconsin.

21 states elected to have HHS run their plan.

Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia and Wyoming.

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You also can check out the news release online at http://www.hhs.gov/news.

Catching up on the past few months

OK, so who said doctors and nurses don’t have a sense of humor.

For example:

The home-health telephone nurse from United HealthCare (motto, we put the Hell in HealthCare) calls to check on me and let me know all about their care options for my post-surgical needs.

The first thing she says, and I am not making this up: “To protect your privacy, this call may be monitored.”

Me: “Whoa, hold up. Let me get this right. To protect my privacy, you’re recording this call. [Emphasis accurate.] How is that protecting my privacy?”

She corrected her statement.

Then she explained that to comply with HIPPA regulations, I need to give her my address to confirm who I am.

Me again: “I’ve rejected HIPPA at all levels of treatment, from you guys (United HellthCare) to my doctors, hospitals and anyone else who would listen. I do not want HIPPA protections.”

HIPPA, by the way, is a federal law designed to protect patient privacy. In general, it’s not a horrible idea. It keeps hospitals from releasing information about you to callers unless you opt out. As a journalist, it gets in my way far too often when checking on gunshot victims or car-crash victims. So I remove that barrier for my friends just out of principle. When the hospital asks me who I authorize to call and ask about my condition, I always write "everyone." It's pretty simple. So simple, even bureaucrats and hospital wonks can understand it.

Nurse: “Well, I need this for HIPPA …”

I cut her off: “I don’t want HIPPA protection. I reject it. You don’t have to worry. It does not apply to me.”

She said it was company policy. I told her that her company gets in the way far too often for my liking and I don’t care about her company policy.

I also explained that she called me. To protect my privacy from ID theft, I don’t give out personal information to people who call me. If I call someone like a bank or an insurance company -- I know who I dialed, after all -- I will provide information to verify who I am.

Me: “You called me. You have my number. You know who I am. I am not giving you personal information”

Her: “Do you want me to add you to a do-not-call list?”

Me: “Yes, please.”

Somehow she was able to do that without verifying who I was.

She’s going to mail me the information she couldn’t talk about over the phone. I'll just toss it.

But to catch everyone up, the reason I received this call in the first place, after missing several over the past few months, is because I had surgeries in January, as noted earlier in the blog, and then again in March, which, oops, I haven’t updated.

The March surgery, again by Dr. Joseph Boyer -- the best thoracic surgeon in Central Florida in my oh-so-humble opinion -- was to repair an incisional hernia in my belly that developed at the site of my original surgery 2½ years ago. I’d been doing yard work and, well, my belly didn’t like that.

I did ask if he had a buy two get one free policy with surgeries. Nope, he doesn't.

So the doctor performed the operation in March and I was out of work for a week to recover. (Seriously, two weeks would have been best, but I didn’t want to blow all my vacation time.)

Still, I did recover, though I may need more work to have this incisional hernia fully repaired.

In the interim, I've had numerous tests.
  • My CT scan of my neo-esophagus came back negative -- Dr. Lee Zehngebot says after one more scan in about a month I won't have to see him three to four times a year; it'll be about once every six months.
  • An endoscopy came back negative -- Dr. Phil Styne said everything between my mouth and intestines looked good. No cancer, no problems, though no pylorus -- he couldn't spot my pyloric valve though he knew it's there. Go figure.
  • A cardiac-stress test came back negative -- Dr. Egerton van den Berg said my heart had no clogs and everything looks good. Safe to do some workouts and work -- as long as I don't move anything heavy and damage the incisional hernia.
  • A respiratory test came back negative -- Dr. Dennis Stevenson says my lungs are at the low end of normal after a chunk was removed in January, but still in the normal range. I don't need lung meds or respirators or inhalers. Whew!
  • My cataract implants are all better -- they had some cells growing on them but a few laser zaps by Dr. Donald J. Centner cleaned them off and I see better than ever.
That's a lot of doctor visits. Some of those incidents involved two and three visits and there were weeks where I was literally in one doctor's office or another every business day of the week.

I was at the doctor so often that I just didn't have enough time to update this blog. Not that I didn't want to, but it was hectic.

Also in the interim, a few friends have had encounters with cancer. I won't name them to protect their identities until I know they'd want me to mention them. (See, I'm implementing HIPPA protections for these friends.)

One has the same type of cancer I did. He's seeing Dr. Z and already has gone through his chemo and radiation. He's kicked butt and is doing great. Surgery is next, and I think he'll be seeing Dr. Boyer. (I reminded him once to mention how great the Yankees are, which will get him on the good side of Dr. B, a major-league Yanks fan!)

A second is undergoing chemo and surviving the ordeal well.
Another is in wait-and-see mode as docs have uncovered potential for cancer but have him being checked regularly to see if it develops.

And a fourth recently had surgery between the ears and has recovered remarkably well.

To each of these guys, I offer my sighs of relief and best wishes that the worst is behind them.

Because I know each can kick this thing's ass. They're all strong men who have petty logical and positive attitudes. And that's one of the strongest assets someone needs as they fight to be CancerVivors.