Health Reform Update: New regulations in place to protect consumers

Yesterday, the U.S. Department of Health and Human Services issued regulations that create a new Patients' Bill of Rights under the Affordable Care Act. These regulations, which apply to nearly all health insurance plans, will help children (and eventually all Americans) with pre-existing conditions gain coverage and keep it, protect all Americans’ choice of doctors and end lifetime limits on the care consumers may receive.

How will the rules help you? They will:

• Stop insurance companies from limiting the care you need. These rules stop insurance companies from imposing pre-existing condition exclusions on your children; prohibit insurers from taking away your coverage based on an unintentional mistake on an application; ban insurers from setting lifetime dollar limits on your coverage; and restrict their use of annual limits on coverage.
• Remove insurance company barriers between you and your doctor. These rules ensure that you can choose the primary care doctor or pediatrician you want from your plan’s provider network, and that you can see an OB-GYN without needing a referral. Insurance companies will not be able to require you to get prior approval before seeking emergency care at a hospital outside your plan’s network.

There are also several other new provisions. More info on all of these new changes can be found at http://healthreform.gov/newsroom/new_patients_bill_of_rights.html.

Families USA Report: Health Reform's impact on Tennesseans with pre-existing conditions

Recently, a Families USA report came out exploring what Health Reform will mean for Tennesseans with pre-existing conditions. The full report can be found here: http://www.familiesusa.org/assets/pdfs/health-reform/pre-existing-conditions/tennessee.pdf.

Here are some of the most important facts we saw in the article:

• There are currently 1,275,000 Tennesseans under 65 years old with pre-existing conditions that could potentially exclude them from insurance coverage. That is ¼ of the non-elderly population.
• There are 115,000 children under 18, and 97,700 young adults aged 18-24, that have pre-existing conditions that could be used to deny coverage.
• These groups transcend all socioeconomic indicators. While individuals below the poverty line are the most likely to have a condition, 23.9% of the individuals making over 400% of the poverty level could be excluded.

Keep in mind that this study is only based on individuals who already have a diagnosis. As primary care becomes more readily available, more individuals will likely discover that they have chronic conditions that require treatments that would otherwise be excluded under traditional health insurance practices.