General Discussion
In reply to the discussion: This message was self-deleted by its author [View all]Ms. Toad
(34,064 posts)The first was not covered. It was not part of the formulary, nor part of the medical coverage. One of the articles I linked you to discussed how insurance companies dealt with it at the time (pretty much not at all). And - if you look for articles at the time, you will find it was routinely denied - even though it saved the insurance company a considerable amount of money. The stupidity of that is why it was popularized on at least one medical drama within a year of my experience with it.
The second was clearly, by the policy, excluded as cosmetic surgery. It was a ridiculous exclusion, but it was an exclusion.
As to the third - that is the closest to being covered in the language of the policy, in that there was an appeal process to petition to have out of network care treated as in-network. There's plenty more.
And, as I said, those are three which are either relatively generic and which I can point to historical or other outside references to provide some support (or, in the first instance, one I have mentioned on DU before).
As for coverage - it has been a variety of coverage over the years, made more difficult because I have a same gender spouse who has not been able to work for a decade (early onset Alzheimers).
We cannot buy insurance on the open market - prior to the ACA, it would have $15,000 - $20,000/year for my daughter alone, and far more for me based on age. Early in her life she was covered by Medicaid - during a period when my income was minimal and, because our marriage is not recognized, neither of us were eligible to be covered under my spouse's policy.
I had private insurance for a while, the company went out of business, and I discovered I was uninsurable by anyone else. I weighed my options and went with a succession of short term policies (~200/year for catastrophic coverage and no pre-existing coverage), on the theory that I was healthy but for this rare pre-existing condition and the worst that could happen was that my pre-existing condition would act up, I'd have one big splash when I was hospitalized, and then I'd have to buy into the open enrollment at several times the cost my daughter would have to pay.
Since then (99+), I have had coverage through work - sometimes at the cost of my emotional health - staying at my most recent position far longer than it was emotionally healthy because it was the only option for covering my entire family. Our options were - put up with an emotionally unhealthy job, or pay whatever the insurance company felt like charging us under COBRA, then the HIPAA conversion to individual coverage.
I recently switched jobs - taking a 60% pay cut (and worse health care benefits) because the job is better for me emotionally and still provides coverage for all of us.
But my daughter would have been off my health insurance 4 years ago because she cannot manage a full time load at school or work, and we would have had to get her on disabilitiy, but for the ACA. She now has the option, because of the ACA, to be a starving artist and not have to work toward a job she hates because it is the only way she can survive. Her billed medical costs are $60,000 in a good year. She literally cannot survive without the ACA.
So I have very little patience with people with similarly devastating conditions, who don't pay enough attention to take advantage of the system and then blast the system which is far from perfect ** but which offers life to people like Will's wife and my daughter. Because blasting it gives ammunition to those who want to destroy it and replace it with nothing.
What the ACA offers is worlds better than what we had before. *All* we got in the last major reform (~1996) was HIPAA individual policies (with unlimited premiums) available only to those who had a job and left it, and *all* we got the time before that (~1980) was COBRA - 18 month policies again, unlimited premiums and only available to those leaving jobs where they had had health insurance. My daughter can't live for another decade and a half waiting for perfection, just because the major reform we got this time isn't anywhere near perfect.