Among Friends

[Mary Bailey]

@Bird mama  thanks for the link!  it refers to getting insurance through the Exchange, getting insurance directly from the insurance company may be different. 

[Bird mama]

@Mary Bailey  I think with PPACA, insurance companies had to look at what they offered differently.  That's how we ended up with pediatric dental and vision coverage (mandated).  I know group health plans were looked at differently than individual members.  I remember as a member of a 'group health plan' nothing really changing for me as it related to dental and vision.  I continue to have medical and RX coverage (for now) provided to me by the group as a retiree.

Where they get me (soon to be considered an individual member) and others is the provision that stipulates that if the dental and vision coverage was offered under a different certificate and was optional (COBRA was optional - they didn't force me) then PPACA and HIPAA don't apply.  I get the one two punch.  They can impose waiting periods.

I completely understand why an insurance company would do it.  Especially with the rule for guaranteed renewability.  You could have someone pay 2 or 3 months of insurance - get expensive dental work - then cancel the policy, if there was no waiting period.  Insurance company loses money and you and I know they hate to lose money.

This is why a couple of weeks ago I had my periodic exam and cleaning.  I told the hygienist and dentist to go over every single tooth, every single margin around the crown.  I explained it this way.  Doctor, as you look at every single tooth, ask yourself, is there anything you see that could wait until January 2021?   I will never have a generous benefit maximum like this again - let's spend Blue Cross' money.