Wellness

[Cakers3]

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@NicksmomESQ wrote:

@Lipstickdiva  Something doesn’t sound right.I would challenge that decision. The ACA made it so all insurance plans had to cover preventative testing at 100%. I’ve learned from previous experience that when you go up the ladder & challenge these things you have a good chance of prevailing.It sounds to me like the insurance company is getting away with it because they’ve gone unchallenged.

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@NicksmomESQInurance plans in place before ACA became law are grandfathered and do not have to comply with the law.

From the American Cancer Society:

The ACA doesn’t apply to health plans that were in place before it was passed in 2010, which are called “grandfathered plans.” You can find out if your insurance plan is "grandfathered" by contacting your health insurance company or your employer’s human resources department. Even if you have a "grandfathered plan," it may still have coverage requirements from state laws, which vary, and other federal laws.

[carlycat]

This is an example of why we cannot get rid of the ACA. 

[hckynut]

@Lipstickdiva ,

Not sure I follow you. You first say Colonoscopy and later say Endoscopy!  Um, having had 15 of 1 and at least 25-30 of the other, the scope goes in opposite ends of the body.

This is a "catch 22" or "chicken or the egg" nonsense. Both of these are "diagnostic procedures" and I would dare any insurance rep to try to tell me differently. These are done Firstly to Diagnose and Secondly to Prevent, in that order.

Even having a heart attack and going to an ER, FIRST comes the Diagnosis, SECOND comes the Prevention. Sounds like an Insurance  rep that knows squat, my wife worked for years with some exactly like them.

Were this me? They would have a big fight on their hands in trying to explain "Prevention verses Diagnostic" and which came first "the chicken or the egg"?

"Dreaded", really?

hckynut

[hckynut]

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@icezeus wrote:

I am speechless not only for you, but also for the poor person who had to do the horrible prep only to be told that the procedure would not be covered.

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@icezeus 

Those things should be known well in advance of even scheduling a procedure. The fault is squarely on the shoulders of this "poor person(?)"!  Horrible prep? A little bit of an exaggeration to me.

hckynut

[Carmie]

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@carlycat wrote:

This is an example of why we cannot get rid of the ACA. 

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The ACA is in effect now.  It did nothing to get some services covered by grandfathered plans and Self insured plans.

Here in PA, our state workers have self insured insurance. The Federal workers also are self insured.  The government itself, does not copy with ACA rules.

[hckynut]

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@Peaches McPhee wrote:

Thanks for the heads-up.  Always good to remember to never assume anything.  

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@Peaches McPhee ,

Knowledge is power and when it comes to Insurance of any kind, even moreso.

hckynut

[Cakers3]

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@hckynut wrote:

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@icezeus wrote:

I am speechless not only for you, but also for the poor person who had to do the horrible prep only to be told that the procedure would not be covered.

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@icezeus 

Those things should be known well in advance of even scheduling a procedure. The fault is squarely on the shoulders of this "poor person(?)"!  Horrible prep? A little bit of an exaggeration to me.

hckynut

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@hckynutI don't mean to laugh but with as many procedures as you had I would guess you have now acquired a taste for the prep solution.  LOL

My poor son had to consume not 1 but 2 containers of the powder mix over 2 days before his surgery.  He said whoever invented this stuff should be executed.  LOL

It isn't the prep I mind; it's not having anything to eat.  I get cranky.  LOL

My doctor doesn't use go.........lightly.  He uses a liquid you mix with water.

[NicksmomESQ]

 @Cakers3  Wow!! I get what you’re saying.I would still file a grievance & press the point.I would also check into the state & other Federal laws that you mention. 

  I say this because a few years ago I helped a friend get something covered by her medical insurance that they insisted wasn’t covered.It took me several months & countless calls.

  Personally,I think the whole medical system is corrupt on so many levels, & has been for decades. We have a broken system that doesn’t look like it’s about to be fixed anytime soon.

[hckynut]

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@Krimpette wrote:

I'm surprised that the doctor's office would not have known in advance that the procedure would not be covered.  SMH.

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@Krimpette ,

Been in many, many doctors offices, and unless asked? Not a single one explained my Insurance Policies to me. Some, I say some offices, don't even have their Insurance Rep in their office. Neither my nephew or nephew-in-law,  both MD doctors, have one on site in their offices.

Not excusing anyone, just stating a fact.

hckynut

[hckynut]

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@2blonde wrote:

@Lipstickdiva   That's awful.  It's bad enough to have to do it, but to pay for it as well?  Seems like a lot of people won't get screened and may actually get the disease, which will cost the insurance company much more!

I think the procedure runs into the thousands of dollars, doesn't it?

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Hi there @2blonde, how you doing?  A Colonoscopy  in my city, on average, costs $3500.

hckynut