really stupid question about Obamacare and insurance companies....

[renate]

My mother-in-law just found out that her insurance company is refusing to pay for a pathologist's report; when she called to ask why, the person she talked to said "blame Obamacare" (I sense that the person at the insurance company didn't use the term as affectionately as we do). Now, I realize I'm hearing this second-hand, but is there anything in Obamacare, rather than in the insurance companies' own policies, that specifically dictates that certain procedures aren't going to be paid for any more?

I don't know why my mother-in-law believes the insurance company's excuse. I personally would never believe anything they said about putting the blame on anything but their own greed; insurance companies have been denying payment for necessary procedures for a long time, and maybe saying "blame Obamacare" is a way of getting half their callers to stop arguing and to blame health insurance reform rather than the company. But I also don't know for an actual fact that certain things won't be paid for any more as a result of Obamacare.

My mother-in-law doesn't watch Fox or anything; she just believes what she was told. If insurance companies are using this excuse often, and it's as wrong as I suspect it is, something needs to be done about it... especially if necessary procedures aren't being paid for, the insurance companies pocket the money, and few people challenge them to pay the charges because "blame Obamacare" is believable to so many people.

Does anybody know whether there's anything to the insurance company's excuse, or is it a flat-out lie?

[sinkingfeeling]

1. No and since the requirements of what insurance companies have to include to be

a part of an exchange hasn't gone into effect yet, it's a flat-out lie.



http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=statline%2Fspecial_report_healthcare_reform_passes.html&_state=maximized&_pageLabel=cntvwr

As previously reported in Statline, this health care reform bill will include a number of provisions impacting pathologists. Among the most immediate is the one-year extension of the technical component (TC) “grandfather”, which till take effect retroactively from January 1, 2010 – December 31, 2010.

The bill also contains initiatives to be developed or expanded over the next several years aimed at testing healthcare delivery models and reducing health care delivery costs. CAP’s letter to Speaker Pelosi addressed each of these provisions:
•Creation of an Independent Medicare Payment Advisory Board (IPAB),
•Expansion of the Physician Quality Reporting Initiative (PQRI) Program
•Clinical Laboratory Fee Schedule Rate Cut
•Increased Funding for Comparative Effectiveness Research
•Payment for Complex Diagnostic Tests
•Identifying Misvalued Codes
•State Grants for Alternative Medical Liability Demonstrations
•Physician Payment Sunshine and Self-Referral Exception
•Establishment of a Workforce Commission

[renate]

2. thank you!

How nice of you to go to the trouble of finding something out specifically about pathologists!

The letter urged lawmakers to pass a permanent fix of the SGR, one of the few major issues not addressed in health care reform, and asked Congress to examine the value of an enhanced role for pathologists in coordinated care models.

“Pathologists are uniquely trained and positioned to assist in delivery system reform since diagnostic testing plays a central role in the direction and management of a patient’s care in virtually all aspects of medicine, from prevention and primary care, to cancer, chronic disease, personalized medicine and public health,” Bauer said. “In this context, pathologists not only ensure that patients get the right test at the right time, but they also protect the health care system against inappropriate requests for an ever increasing complex and expensive array of diagnostic testing.”

So it really was a lie, now and in the future. Quelle surprise!

I'm still really disturbed by this. I know it was just one person's experience, and second-hand at that, but setting aside the political implications of blaming Obamacare or the government when somebody's unhappy with their insurance company, I really do think that this could end up hitting people in the wallet if they just think "oh, you can't fight it, it's the government" and they let insurance companies off the hook instead of contesting charges. More money for the faceless companies and a huge impact on human beings--maybe even medical bankruptcy and everything that Obamacare was designed to help people avoid.

[sinkingfeeling]

3. I found this for you as well. Talks about denial of payment due to coding errors, etc.

http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=cap_today%2Ffeature_stories%2Fbilling_errors_feature.html&_state=maximized&_pageLabel=cntvwr

[renate]

4. you are awesome!

Thank you!