Wednesday, August 27, 2014

Healthcare and Your Rights

Affordable Care Act (ACA)…

What is does it really mean for us?
It was passed in October 2013 and supposed to put consumers back in charge of consumers of their healthcare.  Does it really?

Yesterday I met with a woman who tried to sign up for ACA.  When she attempted to sign up, the system did not recognize her and stated she didn’t exist.  She is a taxpaying citizen that owns her own home. She has a full-time job as a receptionist for a small business that helps children with special mental health needs.  After trying numerous times to get help, she finally reached someone that told her she could potentially get approval if she sent in a copy of her driver’s license to “prove her existence”.  She sent in her license and never heard back from anyone. In the meantime, she never received insurance through the ACA. As well, she had a terrible accident.  She fell and broke her ankle in five places needing surgery and a pin.  She ended up with an infection, needing wound therapy, and a long recovery. She’s still on crutches. All of which have been extremely costly and she needs to pay for everything out-of-pocket without any insurance.  When she tried to get physical therapy she was told she couldn’t get it because she didn’t have insurance.  THIS IS ABSURD!!  What are her taxes paying for? Here is a hard-working woman who has done her due diligence trying to get her coverage from the ACA, & told she “doesn’t exist”. Obviously she does since she works and pays taxes, and now EXCESSIVE medical bills.  How has ACA helped her?  It hasn’t at all; other than to waste her time navigating a broken system while she is now stuck in debt paying medical bills filled with fees that are marked up beyond what market value should be.

There still needs to be a great deal of work done to make sure people have insurance benefits they deserve and they are receiving the benefits they are paying for.

If you are being denied services you feel you are entitled to, you ABSOLUTELY have the RIGHT TO APPEAL.  You may APPEAL more than once. Do NOT GIVE UP!! 

Always review every Explanation of Benefits (EOB) you receive. If you question anything be sure to call the appropriate source.  Whenever you call a doctor’s office or insurance company be sure to document the date, time representative’s name, and service in question you are inquiring about.  Also request a reference number for the call.  Then if appropriate, write an appeal letter and send a letter with the corresponding Explanation of Benefits and Claim via priority mail to your Insurance Company’s Claims’ Review Processing Board and allow 30 business days for processing.  Follow-up if you have not heard any correspondence in 30 days.  Keep copies of everything in a medical file.  

      ~Stephanie Puryear

No comments:

Post a Comment