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Patient Protection and Affordable Care Act

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The devil's in the details - wellness

Last time, our hero received free preventive screenings and $35 co-pays for office visits as well as cheaper generic drugs.

Meanwhile, back at the ranch:

Our heroine’s Blue Cross policy did not change. It was “grandfathered in,” so the law (the Affordable Care Act) does not apply to my policy. I went for my regular, yearly, preventative check up and had to pay $30 for it. My policy has a $500 wellness benefit which paid for a mammogram and part of my lab tests for cholesterol, etc. But. BIG BUT:

My doctor suggested a colonoscopy which is not covered. If I wait until my renewal date, I will get another $500 wellness benefit, which could be put toward a colonoscopy. But then I can’t have a free mammogram next year. My deductible is $1,000, but a colonoscopy costs twice that. If you couldn’t follow that, I’m not surprised. What to do?

I called my husband’s insurance agent and applied for a Blue Shield policy.

Even though the new health care law requires all insurance policies to offer free preventive visits and tests, insurance companies are not required to change policies already in existence (“grandfathered  in”), and policy holders are not required to give up policies they already have. Already existing policies are grandfathered in—they are not subject to the law. I suppose there might be a circumstance where someone would like to keep a policy that did not offer them free preventive visits and tests. I’m just having a hard time thinking what that situation might be. Help me out here. Does anyone know of a situation like that?

Farther down the downside, Blue Shield screwed up our hero’s billing. They continued an automatic withdrawal from our bank account for two months after his new policy started, but applied it to his old policy. His old policy had a different number than his new policy. I will here make a very long and painful story short by just noting that I spent an hour of my time on the phone straightening this out. So did the Blue Shield operator and her supervisor. Could’ve had a free preventative checkup for what that cost everybody. Not to mention the effects on everyone’s health. (Sigh)

According to some estimates, paperwork represents 31 percent of U.S. health care costs.

By the way, the government has put a really helpful guide to the law on their website at; you can see it here: http://tinyurl.com/4vdoyo7.

If you would like me to continue this series, have a question or a suggestion for me, or would like to contribute your own devilish detail, please contact me at: docnangee(at)yahoo.com

Because the preventative services now required to be made available to you at no cost under the Affordable Care Act would, if printed, take up this entire page, you can find them online here: http://tinyurl.com/25t3vm6, or visit our website at RiverJournal.com for the complete list.

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Author info

Nancy Gerth is a freelance writer

Tagged as:

health, wellness, Obamacare, preventative, Patient Protection and Affordable Care Act

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