AAAAAARRRRRRRRRRRRGGGGGGGGGGGGGGGGHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!! [OT]

The senate is considering a bill that would allow insurance companies to
disallow coverage of mammograms and routine exams for children. Employers
could choose to go with the cheaper plan with less coverage.

jmcquown...

Where did you hear this? AFAIK, Employers have always had the ability to
choose what plan to purchase for their employees and the benefits allowable
are purely up to the insurance policy as written. I was never aware of any

jXwXeXrXmXoXnXt...

The problem isn't employers, it's *insurance* companies. Why is the
senate even considering such a bill??

What is the purpose of insurance if not to provide for coverage for the
things *one needs*? Our health care shouldn't be dictated by the needs
of the marketplace.

jmcquown...

That's true; it's not the Employers. They can currently pick and choose
plans as they wish, based on cost. They can also choose whether or not they
contribute anything towards the cost of the insurance plans. But I'm still
not aware of any current legislation which requires insurance companies to
cover annual checkups and mammograms, so to blame *any* administration on
reducing such benefits is really not reality.

mandated coverage "law" for mammograms or routine exams for anyone. (You
might recall I'm a licensed agent in life, AD&D and health.)

Prior to the introduction of HMO's and PPO's, the primary policies purchased
by Employers were Comprehensive Major Medical and most did not cover the
cost of routine exams. Again, depending on the policy language, mammograms
were only covered if the attending physician determined there was a need for
one, rather than simply an annual "preventive" mammogram.

How much more is this administration going to deliberately hurt the lower
and middle classes of this country???!!!!!

kilikini...

They also want to include a mandory routine AIDS test with physicals. I
think that's unfair practice because then future insurance companies can
deny a person coverage.

jmcquown...

That is patently untrue. Insurance companies are not hooked up to some
mystical magical database where they have access to all your medical

CatNipped...

Actually, it is reality. It's another case of the federal government
over-riding state legislation. Our government was set up *purposely* to
allow each state to govern itself, and every time we allow a federal law to
over-ride a state law it's chipping away at our freedom.

Let me clarify. This isn't legislation that allows employers to pick and
choose which plan they want - they can do that now *as long as they obey
state laws on insurance coverage*. This is legislation that says states
can't make their own insurance legislation according to the needs of its
citizens.

records.

An insurance company *may* require a physical exam upon application. It
depends on whether it is an individual policy or a small group policy.
Insurance is based on the concept of spread of risk. Larger groups of
employees or those in an insurance "pool" (such as association plans of
similar employer entities who pool their resources to get coverage) normally
do not have to produce evidence of insurability so the pre-existing
condition exclusion doesn't apply.

I think I understand CN's original post a bit more; the problem is with
insurors, rather than Employers. The Employers have always had a choice of
what plans they purchase.

Speaking as an uninsured, unemployed person who is going in for a mammogram
on Thursday, I can tell you how difficult it was to find a clinic who will

Yowie...

Welll blow me down if Australia isn't trying to do the same thing with
regard to States. Up until this year, it was each individual state that
dictated the minimum employment conditions that every employee had a right
to. Now the federal governement has said "nope, we're going to set those
minimum conditions" and has stripped the rights of every worker back down to
conditions that you'd find in the Industrial Revolution. The States are
going to take it all the way to the High Court, as they can see its not just
about employment conditions, but is jus the tip of taking way each
individual State's independant power. The court case is actually arguing the
Australian Consititution and just what it means to be a federation of
states.

Our healthcare, on the other hand, whilst far from perfect, is functional
and does give free annual mammograms to any woman over 50, and will rebate a
fair chunk of the cost to the patient if the doctor prescribes one.

even see me. They're taking me on a sliding scale based upon how much money
my husband makes. After the mammogram, though, I have no idea how I'm going
to financially face treatment. I may not do anything and just let nature

jmcquown...

Not a good option. There are places (hell, ya'll just drive up here to
Memphis and go to The Med) where they treat "indigents"... I know, I was one
back in 1993. They can't get blood out of a turnip.

take its course.

If I was a single, unemployed person with children, I would be eligible for

CatNipped...

I heard it on Good Morning America this morning. Right now "standard
coverage" includes all tests or recommended doctor visits. This bill will
allow insurance companies to remove *ANY* mammograms or routine doctor
visits for children from coverage. Before this employers could choose to
not cover elective procedures, but had to cover standard procedures.

Jo Firey...

Looking at recent insurance papers, one office visit billed at 164 and
another billed at 100. Medicare allowed 84 for each of them.

CatNipped...

MaryL...

The ADA (American Diabetes Association) has also been asking people to
contact their legislators because a proposed new federal law would preempt
state laws (in many states) that require coverage of diabetes and supplies.

Matthew aka NMR...

I remember when the ADA revised the blood sugar level to a lower point to
allow people to start being treat early for their diabetes. Insurance will
give you a meter, cover the test, cover related illness but not the supplies
required for testing.

Especially when you consider that unemployment insurance is only about
$1200 - $1400 per month!

Medicaid, but as a married woman under 40, I am not.

jmcquown...

I hear ya. I wasn't eligible either. Just a single woman who, if I'd been
able to go to work that day on my new job, for one hour, rather than into
emergency surgery, would have been fully covered.

I am so disgruntled with the way the government is being run and I don't see
it changing for the better.