Politics & Current Events
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Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
If you have questions about this, please email help@theknot.com.
Thank you.
Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
"substandard" plans
the excuse of the week for the 50 million to 100 million plans that are being cancelled is that these are substandard plans with terrible coverage. Of course we've heard some stories in the media, but not as many, about people who were happy with their plans but now as a 55 year old woman they have to move to a plan with maternity coverage or as a man that has contraceptive coverage. This week I read about DC plans that cover abortion and bariatric surgery but not things such as hearing aids. It's hard for me to understand the exact definition of "substandard" when it seems like hearing aids would be so much more important to the quality of life of a 50 year old man vs. having contraceptive coverage. This morning in the Washington Post there is a story about how NOT ONE plan in the New York exchanges covers services provided at Sloan Kettering hospital which is (and I quote) "one of the world's largest and most respected cancer hospitals". So people who are forced onto the exchanges due to cancelled policies no longer have "substandard" policies however we're ok with forcing them into substandard care?
http://www.washingtonpost.com/business/new-health-plans-sold-through-exchanges-not-accepted-at-some-prestigious-nyc-hospitals/2013/11/20/7538dbb4-5235-11e3-9ee6-2580086d8254_story.html
Interestingly enough, another issue that the ACA was supposed to solve was to cut through some of the bureaucratic red tape on benefits not being paid, etc. It seems that the issue here is the hospital itself has declined to participate with these carriers as they do not have a tested or strong record on payment of benefits.
There is no doubt in my mind that some people may have had insufficient insurance for their needs. However my understanding is that there are NO dental requirements for policies under the exchange plans while there are contraceptive and prescription requirements. Pretty much everyone needs dental care whether you are 5 or 95, male or female. Poor dental health has been directly linked to increased incidence of heart disease, miscarriage and dementia. It increases the risk factor of low birth weight babies and makes it harder for diabetics to control their sugar. It is actually not that uncommon for people to die from infections in their mouth, especially children. So essentially every.single.person who buys an exchange plan will have a substandard policy using what seems to be the going loose definition of what a substandard policy is. Is dental care just not as sexy of an issue as access to plan b so they just decided to ignore it when they put together this boondoggle?
http://www.washingtonpost.com/business/new-health-plans-sold-through-exchanges-not-accepted-at-some-prestigious-nyc-hospitals/2013/11/20/7538dbb4-5235-11e3-9ee6-2580086d8254_story.html
Interestingly enough, another issue that the ACA was supposed to solve was to cut through some of the bureaucratic red tape on benefits not being paid, etc. It seems that the issue here is the hospital itself has declined to participate with these carriers as they do not have a tested or strong record on payment of benefits.
There is no doubt in my mind that some people may have had insufficient insurance for their needs. However my understanding is that there are NO dental requirements for policies under the exchange plans while there are contraceptive and prescription requirements. Pretty much everyone needs dental care whether you are 5 or 95, male or female. Poor dental health has been directly linked to increased incidence of heart disease, miscarriage and dementia. It increases the risk factor of low birth weight babies and makes it harder for diabetics to control their sugar. It is actually not that uncommon for people to die from infections in their mouth, especially children. So essentially every.single.person who buys an exchange plan will have a substandard policy using what seems to be the going loose definition of what a substandard policy is. Is dental care just not as sexy of an issue as access to plan b so they just decided to ignore it when they put together this boondoggle?
Re: "substandard" plans
As I pointed out in another post, some health plans (including Medicaid and Medicare) do not pay for reconstructive surgery after mastectomy. Ironically enough under current law most carriers are required to but Medicaid and insurance provided by government entities or religious organizations are not required to. This did not change under the ACA. They also don't cover hearing services in many states. In some states they don't cover respiratory or speech therapy including after you've had a stroke. Based on that I'd call Medicaid pretty substandard.
Also, doctors are not required to participate in any particular plans. You could have great coverage with a great record of payment from the insurer that your physician accepts. Now you may get dropped and forced to another carrier which your doctor does not accept. A good example of this goes back to the dental thing in which at one time in town here we had one single dentist who accepted Medicaid. Sure you had coverage but he was booked solid almost a whole year out. Have an emergency? You can forget getting in to see him. Also a few years ago my OB/Gyn closed up shop. Turns out they were the only OB/gyns in town that took medicaid and there was much handwringing in the papers especially with regard to the women in their care who were currently pregnant. No other providers in the area were willing to take them on.A 2011 study published in the New England Journal of Medicine found that many doctors refuse to see Medicaid children complaining of seizures, uncontrolled asthma, and even broken arms. A study of Oregon's expansion found that Medicaid coverage has had virtually no effect on things like high blood pressure, sugar levels, etc. which are all things that put you are high risk for more costly medical conditions.
You could very well see the same effect with insurance carriers who develop bad reputations. Since so many have been forced out of the market in certain areas, you could have insurance but no health care which is very different.
Regardless of Dental Insurance being treated differently than health insurance by some carriers, if health care is a fundamental "right", we don't think dental care is or at least falls under the auspices of health care?