By Ronale Tucker Rhodes, MS
Imagine being told that your insurance company was no longer going to cover the cost of your or a loved one’s immune globulin (IG) treatments? Either you’ve exceeded your yearly coverage limit, your son or daughter is getting ready to turn 18 and has no job with benefits, or you’ve just been sick too long, which means you’ve reached your lifetime cap — you’ve exceeded all available benefits.
Oh, right, I guess many of you reading this probably don’t have to imagine this, do you? And, if you have imagined it or are imagining it, it’s because of a genuine and legitimate fear — the fear that the cost of your medication is more precious than your life.
And while it’s hard for those in the IG community to imagine that such an injustice could actually be a reality in our society, try describing this scenario to the naysayers of healthcare reform who are completely unaware of the critical necessity of being treated with IG, the high cost of the treatments and the constant battle with insurance companies that many of you have to endure year after year just to stay alive. I have, and their answer is almost always: “I can’t imagine that can really be true!”
Well, imagine this: Fear less. No, not all of your problems with insurance coverage are going to go away with the passing of the new healthcare reform. But, there are many positive reforms that pertain specifically to you. Starting yesterday, September 23, here are some of the changes that took effect that are most important to you:
• Health plans can no longer put lifetime limits on coverage.
• “Essential benefits” (hospital services, drugs, emergency services and maternity and newborn care) offered through employer and individual plans can’t be capped any lower than $750,000 a year. That is set to increase each year until 2014, when the yearly cap is eliminated altogether.
• Children (under 19 years of age) with pre-existing conditions can no longer be denied insurance coverage. This will become effective for adults, as well, no later than 2014.
• Insurance coverage for young adults can be extended up to their 26th birthday through their parents’ insurance policy.
(Note: Even though the law went into effect September 23, don’t expect changes until January 1. This is because health plans don't have to implement the provisions until their next annual renewal date.)
Healthcare reform has been a long battle, an many naysayers have ignored the damaging effects to some, especially to chronically ill patients. How many naysayers of healthcare reform have you encountered, and what would you say to them now? I’d say, imagine this: When you or someone you love becomes chronically ill in need of a life-saving medication, be glad that healthcare reform passed, because now your and their life is more important than the cost of the care.