Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

Pre-Existing Conditions Plans (PCIP)

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Inchlingblue:
I didn't realize that part of the federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act calls for establishing bridge plans for people with pre-existing conditions so that they can have insurance until the rest of the law comes into effect in 2014.

This is great!  This link has all the pertinent information about how to find out more as well as a story about a man who had a kidney transplant and has to take meds that cost about as much as an average ARV combo:

http://www.nytimes.com/2011/03/19/health/19patient.html?ref=health

Inchlingblue:
I knew there had to be a catch:


You must be uninsured for at least six months to be eligible for a plan. That means people already enrolled in state high-risk pools or private insurance cannot apply, even if the new plans would be far less expensive. Unemployed people who are on Cobra or whose benefits have only recently expired are also not eligible.

Why is it that these things have to make it so difficult for those of us with chronic conditions? So you have to go without insurance, find a way to access meds for SIX MONTHS and then you qualify. Gee, thanks!

And more hoops to jump:

To qualify for a federally run plan, you will need proof that you have applied for individual insurance and that a carrier denied you coverage because of a pre-existing condition, or proof that a carrier approved coverage but with a rider that excluded payment for your pre-existing condition.

Do you also have to recite all of Shakespeare backwards while standing on your head making a souffle? The whole time not receiving the medications that mean the difference between staying healthy and dying.

DanMo:
Sometimes I HATE living in the United States.

I thoroughly believe that democracy is DEAD in the US. What we have now is an plutocracy, "rule of the rich". Our "representatives" in Congress care more about lining the pockets of the corporations who pay for their campaigns, than the welfare of the common person.

If you notice, those catches are designed to make it easier on the Insurance Companies rather than make it easier for people to get insurance.

Although I will concede that the ACA is a huge step forward. Can't wait and see how things will be when the Law is FULLY implemented in 2014.

Dan

P.S. I still think the Dems are a bunch of wussies for not charging through with a "public option".

Inchlingblue:
You make a lot of good points Dan.

The thing about those particular catches is I don't even think they benefit insurance companies. These PCIP policies are subsidized by Federal money.

It should be enough that a person shows they have a pre-existing condition based on their medical records, period.

If they want to take it a step further and make people show a letter of rejection from an insurance company, fine. But what I don't get is the screwed up logic of making people then go SIX MONTHS without insurance! We're talking people with pre-existing conditions; these are precisely the most vulnerable people who should not go without insurance for even a day let alone six months.

I'd be curious to know what is the "reasoning" behind making people go uninsured for 6 months before they're eligible for a PCIP?

When making such rules do they factor in that apart from being ethically questionable it makes no financial sense? It will cost a lot more in the long run when those people who have not actually died after waiting six months will likely have more medical complications that will have to be dealt with?

DanMo:
I also find it ridiculous. It makes no sense whatsoever; it's bureaucracy at it's most horrible. It's incompetence and a general lack of understanding the issues which they legislate.

A simple rejection from an insurance company should suffice. I don't understand the reasoning behind it at all.

Dan

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