Good news first, then the bad:
The last time I went to the pharmacy I used my new Prescription insurance, Blue Cross Blue Shield Bronze Plan, and I thought I did something wrong when the clerk told me my prescriptions had no co-pay! I was very excited about that. I also got a decent price on my antibiotic. So that is the plus.
The cons are that I was never notified by my plan Blue Cross that I had to use preferred labs! So now, I just got slapped with a $900 lab bill for a service that should have been covered under the ACA. The insurance company did not send the book explaining my benefit plan, instead all I got was a card and a bill. It was on me to investigate my plan and make sure that I was using preferred labs. I was supposed to log on and check the benefits before I went to my doc. This info was buried on page 18 of the 52 page document. Apparently insurance companies can get away with these types of practices, so I am going to appeal the coverage decision (a new guaranteed right under ACA). Not sure how it will come out, but more likely than not, I will lose.. Just a warning to those of you who may have a Bronze plan. The Silver and Gold plan do not require you to use preferred labs with Blue Cross.
Recently I gave a talk and overview of the ACA. Here are some key points to know:
•March 31st is the deadline to enroll for 2014 coverage and avoid being taxed! if you miss it, the tax penalty (Individual Mandate) will be $95 per person or 1% of household income, which ever is higher, and if applicable $47.50 per child under 18
- The ACA bans lifetime limits on coverage for most benefits
- College age children get coverage on parent’s plan until age 26
- Women’s preventative care covered–well woman visits (pap smear, pelvic exam)
- Contraception (religious organizations exempt)
- Mandates coverage for those with pre-existing health conditions, and children under 19 with pre-existing condition cannot be limited (cancer, long term disease)
- The ACA guarantees right to appeal coverage decisions.
- Medicare patients, (seniors over age 65) can get key preventive services for free, and also receive a 50% discount on brand-name drugs;
- The Medicare Part D “donut hole. (will be eliminated by the ACA over time)
The Keli R. Edwards Law Office, LLC 