Washington, Sep 22 - Today, Congressman Bill Owens announced several provisions of recently enacted health care reform to take effect tomorrow, September 23rd. Thursday is the effective date for multiple consumer protections under the Affordable Care Act, including the Patient’s Bill of Rights.
“These new protections enacted by recent health care reform law will put patients back in control of their medical care, and help to put an end to abuses by the insurance industry,” said Owens. “Additionally, these provisions will bring down costs in the health care industry, which will help us to reduce the debt and future annual deficits. Implementing widespread preventive care will cut down on expensive future catastrophic care that drives up both public and private costs.”
For plan years beginning on or after September 23, 2010, privately-insured consumers will have the following protections:
• Health coverage cannot be arbitrarily cancelled if you become sick. Until now, insurance companies were able to retroactively cancel your policy when you became sick, or if you or your employer made an unintentional mistake on your paper work. Under the new law, health plans are now prohibited from rescinding coverage except in cases involving fraud. Health care reform has made these rescissions a thing of the past.
• Children cannot be denied coverage due to a pre-existing condition. Each year, thousands of children who were either born with or develop a costly medical condition are denied coverage by insurers. New law prohibits insurance plans both from denying coverage and limiting benefits for children based on a pre-existing condition. These protections will be extended to Americans of all ages starting in 2014.
• Children up to age 26 can stay on their parents’ health plan. Currently, one in three young Americans are without health coverage. Under new law, insurance companies are required to allow young people up to their 26th birthday to remain on their parents’ insurance plan, at the parent’s choice. This provision applies to all health plans.
• Health insurance giants cannot put a lifetime limit on health coverage. Millions of Americans who suffer from costly medical conditions are in danger of having their health insurance coverage vanish when the costs of their treatment hit lifetime limits. The new law prohibits the use of lifetime limits in all health plans.
• Health plans’ annual limits are phased out over three years. The annual dollar limits on what an insurance company will pay for health care will also be eliminated gradually over a span of three years.
Beginning Thursday, consumers purchasing new plans will have the following additional protections:
• Patients have the right to choose their own doctor. Being able to choose and keep your doctor is a highly valued aspect of the American medical system. Yet, insurance companies don’t always make it easy to see the provider of choice. The new law guarantees a patient the choice of their primary care doctor; allows a patient to choose a pediatrician as their child’s primary care doctor; and gives women the right to see an OB-GYN without having to obtain a referral first.
• Preventive services will be available without deductable or co-payments. Too many Americans do not get the high-quality preventive care they need to stay healthy, avoid disease and lead productive lives. Nationally, Americans use preventive services at about half the recommended rate. Under the new law, insurance companies must cover recommended preventive services, including mammograms, colonoscopies, immunizations, and pre-natal and new baby care, without charging deductibles, co-payments or co-insurance.
• Patients have the right to both an internal and external appeal. All too often a health plan tells a patient that it won’t cover a treatment a doctor recommends or it refuses to pay the bill for a child’s last trip to the emergency; consumers may not know where to turn. Most plans have a process that lets you appeal the decision within the plan through an “internal appeal” If one loses this internal appeal, they may not be able to ask for an “external appeal” to an independent reviewer. The new law provides the right to an impartial “internal appeal.” Also, insurance companies will be prohibited from denying coverage for needed care without a chance to appeal to an independent third party.
• Patients have the right to access out-of-network emergency room care at in-network cost-sharing rates. Many insurers charge unreasonably high cost-sharing for emergency care by an out-of-network provider. This can mean financial hardship if a patient if they get sick away from home. Health care reform makes emergency services more accessible to consumers. Health plans will not be able to charge high cost-sharing for emergency services that are obtained out of a plan’s network.