There was a time when I would've considered the ACA unnecessary. That I would've been annoyed by it. This was also a time where I had little to no interest in politics. It's funny how life has a way of humbling a person and teaching them something new about themselves on a regular basis. This is a story about how I ended up needing the help in order to make myself better.
"Well why didn't you just get a new inhaler?" I felt a sinking pit in my stomach. I was at a follow up visit to my doctor after ending up in the ER a few weeks before because bronchitis had made my asthma worse and I couldn't breathe. The first thing my doctor asked me was where my inhaler was when this had happened. After all, that was in my plan. I tried to explain to her that I only had one inhaler and it had been stolen the week before when I was riding the bus. Somehow, despite my explanation she didn't understand that since I was uninsured at the time, I just couldn't afford a new one. It was only after the ER trip that a friend of mine had pity on me and bought the inhaler for me.
I lost my insurance in April 2012 because I had been working at a call center that had outsourced its customer service department overseas. This was my fourth lay off in about six years. The whole time I had been trying to go back to school but in playing musical jobs I had never managed to do so. I decided to make school my focus and work secondary and deal with it.
Because I have asthma, I've never been able to get insurance without going through my work before. COBRA would've cost me over six hundred a month, and while my state had opened a high risk pool, it was still too expensive. My NP was awesome and made sure I got refills of my medication before I lost my insurance and gave me a list of community services for when I did lose it, because she knew I wouldn't be able to come back afterwards.
I did everything I could to make sure I would be taken care of. I signed up for a prescription plan at a local pharmacy, I found local clinic that was free, run on community donations. Still there are things that free clinics couldn't handle. Waiting all week to see a doctor because you got sick on Sunday and the free clinic is only open on Saturday isn't helpful when you're so sick you can't breathe. The doctors are volunteers so there's no guarantee of continuous care. In fact, the push is to get you into a local public health or community clinic, but they often were not taking new adult patients or were an hour drive away.
It was about a month after I lost my insurance when I found a lump on my right side, along the edge of the breast tissue. The free clinic provided me a referral but when I called the places they suggested I was turned away. I was told I was too young, that the office no longer provided services, or that they were out of funds for the year. I continued to fight to find a way to access services, but without a referral from a PCP I was getting nowhere. I finally took the time to bus out to one of the few clinics taking patients. They contacted a local imaging center attached to a public hospital to get me in. This started in June, I was finally in for imaging in October. In November I would get a biopsy and find out it was benign. It took me six months from start to finish to find out what was there.
It would be another year before I would get insurance again. In that time I ended up in the ER enough times the doctors started to recognize me. There really wasn't anything either of us could do. I couldn't manage my health without being able to afford regular doctor's visits and medication and they couldn't make a solution appear out of thin air. My wisdom teeth got infected and had to be removed but had to wait two months for a dentist who would help. I was on antibiotics so long I ended up with a GI infection. Bronchitis, allergic reaction, a set of second degree burns from how bad at cooking I can be. They got to deal with it all, despite the fact that most of these things were preventable.
All if this changed in January of last year. I live in one of the states that approved the Medicaid expansion and set up their own healthcare exchange. I was there on day one to shake hands with the Governor, tell him my story, and sign up. I stood up with him to others to encourage them to use the exchange as well. It is the only day of class I've missed since I started back.
Because of the Affordable Care Act I was able to get needed blood work that I had not been able to afford. Reliable access to medication. The first thing my PCP did, remembering how just a few months earlier I had ended up in the ER because I didn't have an inhaler was make sure to get me a prescription for one so I had a backup. One thing I know is I appreciate the opportunity more than I could ever express.
I know there are naysayers out there who will tell me that those things are not really free and that someone has to pay for them. One day I'll graduate and that person will be me. I seriously hope that I am paying to make sure someone gets the care they need with the money I pay into the system. It's saner than paying for what happens when they can't. The system we have isn't perfect, but it can only get better if we put effort into it.
Insurers aren't actually charging for fertility treatment for 60 year olds since that would be a violation of the actuarial value requirements of the ACA. The predict how many people would likely use various types of coverage (which wouldn't include coverage of prostate conditions for women, for instance), so no, you're not paying for that.
ABA treatment coverage is actually required for ACA plans in MA.
Coverage for major healthcare costs is required because the care that produces those costs is required to be provided. If a hospital is legally required to provide that care, it only seems fair that people should be legally required to help ensure that bill can be paid.
Just like prior to the ACA, you have the option of either a higher deductible plan with lower premiums, or to reduce your deductible by paying higher premiums. I would love to pay only $6k in premiums, but like the average person who gets their insurance through their employer, my insurance costs about $15k, and while my deductible is lower than yours, I'm paying an extra $9,000.
I'm not sure if you read the part that states we have Blue Benefits which is a third party through BCBS, (through employment) but they do not cover ABA. We would have to pay for another insurance that covers it, so I am not sure what you're experience is with this, but this is our situation.
I would be more than happy for you to walk me through the process of getting this service for my son, because all the ABA providers who have contacted our insurance company and was informed that they do not cover ABA because it is "discreet trial." So if you have more knowledge on the matter, I'm am open to suggestion.
FYI: Just because we live in MA doesn't mean our insurance is out of MA. My husband works for a franchise, whose head office is not in MA.
Bottom line, i'm paying a premium for something I am not getting any use from.
I'm not sure if you read the part that states we have Blue Benefits which is a third party through BCBS, (through employment) but they do not cover ABA. We would have to pay for another insurance that covers it, so I am not sure what you're experience is with this, but this is our situation.
I would be more than happy for you to walk me through the process of getting this service for my son, because all the ABA providers who have contacted our insurance company and was informed that they do not cover ABA because it is "discreet trial." So if you have more knowledge on the matter, I'm am open to suggestion.
FYI: Just because we live in MA doesn't mean our insurance is out of MA. My husband works for a franchise, whose head office is not in MA.
Bottom line, i'm paying a premium for something I am not getting any use from.
BCBS does cover and have criteria for covering ABA in Massachusetts:
It's certainly not unusual for private insurances to attempt to get out of paying claims, which appears to be what they're doing with you. Denying ABA claims because they consider them to be "discreet trial" (referring to discreet trial therapy-DTT) doesn't make a whole lot of sense since DTT is a type of ABA and is the type of ABA typically provided in clinical therapy. I would ask them to clarify why your claims don't meet their published requirements, or better yet see if you Physician will help clarify what they would like to see in order to provide the coverage they claim to provide.
It's certainly not unusual for private insurances to attempt to get out of paying claims, which appears to be what they're doing with you. Denying ABA claims because they consider them to be "discreet trial" (referring to discreet trial therapy-DTT) doesn't make a whole lot of sense since DTT is a type of ABA and is the type of ABA typically provided in clinical therapy. I would ask them to clarify why your claims don't meet their published requirements, or better yet see if you Physician will help clarify what they would like to see in order to provide the coverage they claim to provide.
Seriously I wish you would read before you answer, I DO NOT HAVE BCBS!! I have a third party insurance though it called Blue Benefit! Understand now? Let me break it down so that you can understand it. Its like Lexus and Toyota, both are made by the same company but they are two different vehicles.
Don't you think I have read every link you are sending me several times already? When you have a child we this disability you almost become an expert in it.
I am not trying to change anyone's mind from like Obamacare. I don't like it because it serves me no purpose. Besides, if it sooooooooo great why don't the politicians have it?!
Seriously I wish you would read before you answer, I DO NOT HAVE BCBS!! I have a third party insurance though it called Blue Benefit! Understand now? Let me break it down so that you can understand it. Its like Lexus and Toyota, both are made by the same company but they are two different vehicles.
Don't you think I have read every link you are sending me several times already? When you have a child we this disability you almost become an expert in it.
I am not trying to change anyone's mind from like Obamacare. I don't like it because it serves me no purpose. Besides, if it sooooooooo great why don't the politicians have it?!
Sorry for misreading, but you said have a Blue Benefit plan which is through BCBS, meaning BCBS licenses them as administrators of a BCBS plan that complies with BCBS requirements, including BCBS autism coverage policies. Did they say they weren't going to cover the claims because they don't cover ABA services, or did they say weren't going to cover it because they considered it be discrete trial training and not ABA?
Do you have an Obamacare (insurance exchanges) plan or an employer provided plan? I had the impression this was an employer provided plan.
Members of the House and Senate, as well as their staff members all have plans bought on the exchanges.
In 2013 in one night there were 600,000 that were homeless. Interestingly enough if you read the whole report, this is a reduction of 6% or 40,000 since 2010
Specializes in Mental Health, Gerontology, Palliative.
I am not trying to change anyone's mind from like Obamacare. I don't like it because it serves me no purpose. Besides, if it sooooooooo great why don't the politicians have it?!
If they are anything like our politcans, they probably have state and federal benefits, all paid for by the tax payer
Specializes in Mental Health, Gerontology, Palliative.
jaycam, when you get a nursing job, you should work for free. everyone deserves free healthcare, right? if you accept a paycheck, then you are a greedy profiteer.
Let me bust this wide open. Speaking as a nurse in a country that has that awful thing called universal healthcare. I earn a living, and I earn a damm good one
My sister the doctor, also earns a very good living as does my other sister who is a radiographer and MRI tech.
Phoenix16, RN, MSN
107 Posts
I'm not sure if you read the part that states we have Blue Benefits which is a third party through BCBS, (through employment) but they do not cover ABA. We would have to pay for another insurance that covers it, so I am not sure what you're experience is with this, but this is our situation.
I would be more than happy for you to walk me through the process of getting this service for my son, because all the ABA providers who have contacted our insurance company and was informed that they do not cover ABA because it is "discreet trial." So if you have more knowledge on the matter, I'm am open to suggestion.
FYI: Just because we live in MA doesn't mean our insurance is out of MA. My husband works for a franchise, whose head office is not in MA.
Bottom line, i'm paying a premium for something I am not getting any use from.