This is basically good news if you fit into the parameters of this next level. It is still a pain and everybody hates this qualification process and when you are sick this is the last thing on one’s mind, but it looks like complicated algorithmic formulas are going to the the path that needs to be take to get care when you need it since everyone is totally consumed with business intelligence and better outcomes and sometimes the 2 even cross paths. There’s always a link at the Medical Quack for the HHS site, Healthcare. Gov under the right hand resource column.
I think they did the best they could in view of all the soap opera and non participants that work in Congress today where so many agree to disagree. Some plans are grandfathered and some of the provisions may not apply so like always, get out your reading glasses and spend a few minutes or hours and try to digest all of this. I think patients would like having care outside of a data table at times, and I fully realize the value of electronic medical records and how they save lives and are needed, but even that is screwed up as we are to the huge levels of data today where all of this makes it a lot harder to work with. Transactions make huge profits for Wall Street and those come right out all the various data services needed in the mountains of data we have today. Some Medicare contractors are owned and operated by insurance companies too, so I guess this is about as good as it can get with the carriers having the machine gun technology and the rest of us having swords daggers.
One thing I see getting tougher are the anti fraud algorithms as carriers will probably increase that action to get out of some high expense areas, but nothing new here as that has been done for years but this new effort could go on steroids now and even those with cancer might unfortunately be at the mercy of someone using their algorithms to somehow twist things around.
There are some improvements and again the rest is over a few years to fall into place but the mathematics will get ugly so prepare for battles as the dividends of the Wall Street insurance companies by law still have to come first. Sounds like a good case for either going back to non profit or a single pay type of system. You can’t really blame the administration on this one as they dealt with what was out there to work with for one and so many members of Congress don’t understand how technology is changing the world and healthcare, so thus we had a ton of 70s thinking out there with non participants and those preaching “Magpie Healthcare”. I hope this book open some eyes out there and encourages people to enter the current century as you can’t believe everything you hear and mathematical manipulation of numbers is what is driving everything with both accurate queries and desired queries for profit. I have been saying this over 2 years on the blog and now that someone else has written a book with trying to bring this reality to many, maybe folks will wise up. BD
“Proofiness–The Dark Side of Mathematical Deception”–Created by Those Algorithms–New Book Coming Out Soon
September 23, 2010 represents a new day for American consumers in our health care system. This is the day that a series of new rights, benefits, and protections under the
Affordable Care Act
The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.
begin to bring to an end some of the worst abuses of the insurance industry. Combined, these new will put consumers, not insurance companies, in charge of their health care. Below is a brief summary of the new restrictions for insurance companies and new rights for consumers beginning to take effect:
Insurers Will No Longer Be Able To:
- Deny coverage to kids with pre-existing conditions. Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition like asthma.
- Put lifetime limits on benefits. Health plans can no longer put a lifetime dollar limit on the benefits of people with costly conditions like cancer
- Cancel your policy without proving fraud. Health plans can’t retroactively cancel insurance coverage – often at the time you need it most - solely because you or your employer made an honest mistake on your insurance application.
- Deny claims without a chance for appeal. In new health plans, you now have the right to demand that your health plan reconsider a decision to deny payment for a test or treatment. That also includes an external appeal to an independent reviewer.
Consumers in New Health Plans Will Be Able to:
- Receive cost-free preventive services. New health plans must give you access to recommended preventive services such as screenings, vaccinations and counseling without any out-of-pocket costs to you.
- Keep young adults on a parent’s plan until age 26. If your health plan covers children, you can now most likely add or keep your children on your health insurance policy until they turn 26 years old if they don’t have coverage on the job.
- Choose a primary care doctor, ob/gyn and pediatrician. New health plans must let you choose the primary care doctor or pediatrician you want from your health plan’s provider network and let you see an OB-GYN doctor without needing a referral from another doctor.
- Use the nearest emergency room without penalty. New health plans can’t require you to get prior approval before seeking emergency room services from a provider or hospital outside your plan’s network – and they can’t require higher copayments or co-insurance for out-of-network emergency room services.