Current Events > insurance rejects mans $35k bill due to pre-existing conditions

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Balrog0
11/25/19 12:51:12 PM
#1:


https://www.inquirer.com/health/consumer/pre-existing-conditions-aca-lawsuit-health-insurance-20191125.html

The 57-year-old plumber initially dismissed his shortness of breath as an inevitable consequence of getting older and having smoked as a younger man. But when his symptoms worsened in early 2017, he went to his doctor, who told him to go to the hospital immediately. There, he learned the problem was more serious than he thought: heart failure and type 2 diabetes.

The situation became even more dire months later, when the bills for tests and scans during his nearly week-long hospital stay came and his insurance plan refused to pay, leaving him with $35,000 in medical debt.
Even though he had just been diagnosed, heart failure and diabetes, according to his plan, were pre-existing conditions.

Once a common practice, the Affordable Care Act banned major medical plans from denying coverage for pre-existing conditions, or medical issues that existed before enrollment. But LaFrance didnt have major medical insurance. Hed mistakenly purchased short-term limited-duration insurance, a type of plan that has become more readily available under the Trump administration. Its less expensive, but also less regulated, and is allowed to refuse to pay for services related to pre-existing conditions.

reminder that this was a common occurrence before the ACA

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Lairen
11/25/19 12:54:52 PM
#2:


When this happens to me ill just die and no one will care. Im not being a jerk to this guy but just pointing out thats what happens now. Hope you dont get it but when you do just accept that insurance companies fucked you and no one cares
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AlCalavicci
11/25/19 12:55:25 PM
#3:


Lairen posted...
When this happens to me ill just die and no one will care. Im not being a jerk to this guy but just pointing out thats what happens now. Hope you dont get it but when you do just accept that insurance companies fucked you and no one cares


this is exactly why we are in the situation we are in with medical insurance

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Alucard188
11/25/19 12:56:18 PM
#4:


I'm reminded of the guy from Chicago area last year, who won $1000000 in the lottery. With the winnings, he finally decided to go to the doctor. He hadn't been feeling right for the last six months, and this gave him the financial capital to do so.

It was stage 4 cancer, and he died in two weeks. Good old American dream right there.

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Hanky_Bannister
11/25/19 12:59:24 PM
#5:


Balrog0 posted...
Trump administration. Its less expensive, but also less regulated, and is allowed to refuse to pay for services related to pre-existing conditions.

Trumps shitty america
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AsucaHayashi
11/25/19 1:00:30 PM
#6:


"not me"
"he probably had it coming"
"not me"
"as long as i save more money on taxes"
"not me"
"shrug emoji"
"not me"
"that's life"
"too bad so sad"
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CommonStar
11/25/19 1:02:04 PM
#7:


"people love their private insurance"
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tremain07
11/25/19 1:02:22 PM
#8:


It's going to get so much worse
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Lairen
11/25/19 1:03:10 PM
#9:


AsucaHayashi posted...
"not me"
"he probably had it coming"
"not me"
"as long as i save more money on taxes"
"not me"
"shrug emoji"
"not me"
"that's life"
"too bad so sad"


When i die, no matter how, besides very close family and friends, no one will care.

If my daughter dies, ill be destroyed, while very few others will care.

As is the case with most everyone.
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Sexypwnstar
11/25/19 1:04:22 PM
#10:


Lairen posted...
AsucaHayashi posted...
"not me"
"he probably had it coming"
"not me"
"as long as i save more money on taxes"
"not me"
"shrug emoji"
"not me"
"that's life"
"too bad so sad"


When i die, no matter how, besides very close family and friends, no one will care.

If my daughter dies, ill be destroyed, while very few others will care.

As is the case with most everyone.


At least you have friends
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#11
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Balrog0
11/25/19 1:09:47 PM
#12:


Crono99 posted...
As a canadian, I find this absolutely mind-boggling and terrifying.

How are americans okay with this?


some dude said make america great again a bunch

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Hanky_Bannister
11/25/19 1:10:31 PM
#13:


Crono99 posted...
Balrog0 posted...
week-long hospital stay


Balrog0 posted...
$35,000 in medical debt


As a canadian, I find this absolutely mind-boggling and terrifying.

How are americans okay with this?

we are mostly stupid and thats proved by who's president...
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#14
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ScazarMeltex
11/25/19 1:13:33 PM
#15:


If my cancer comes back and im not insured through an employer the same thing will happen to me.
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AlCalavicci
11/25/19 1:17:01 PM
#16:


Crono99 posted...
As a canadian, I find this absolutely mind-boggling and terrifying.

How are americans okay with this?


literally greed

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Balrog0
11/25/19 1:17:45 PM
#17:


ScazarMeltex posted...
If my cancer comes and im not insured through an employer the same thing will happen to me.


in most states you should be able to access medicaid retroactively if that's the case, although yeah if you make too much for that but still dont have ESI you're definitely in trouble!

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ExtremeLuchador
11/25/19 1:32:51 PM
#18:


People are deliberately going bankrupt when they get majorly ill or hurt. To get Medicaid.
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Balrog0
11/25/19 1:34:38 PM
#19:


Im pretty sure they're just running out of money

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TheVipaGTS
11/25/19 4:13:32 PM
#20:


https://youtu.be/VYOjWnS4cMY

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malenz
11/25/19 4:17:15 PM
#21:


Balrog0 posted...
some dude said make america great again a bunch

can I sig this
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PatrickMahomes
11/25/19 4:28:29 PM
#22:


Crono99 posted...
Balrog0 posted...
week-long hospital stay


Balrog0 posted...
$35,000 in medical debt


As a canadian, I find this absolutely mind-boggling and terrifying.

How are americans okay with this?

We're not, but sadly those who profit off things like this are totally fine with it.
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#24
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#25
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Balrog0
11/25/19 5:11:49 PM
#26:


Nall posted...
Were not, but none of us really have the power to change our medical system. Seems like its a constant struggle in Washington to fix our healthcare system, but all the fixes they manage to crap out in between all the fighting is just a different kind of terrible for us.


This particular instance is a direct consequence of trump being president; it had been fixed under Obama

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Sad_Face
11/25/19 5:14:31 PM
#27:


Lairen posted...
When this happens to me ill just die and no one will care. Im not being a jerk to this guy but just pointing out thats what happens now. Hope you dont get it but when you do just accept that insurance companies fucked you and no one cares

This defeatist mindset gets people NOWHERE. Have you no ambition? Are you comfortable settling for mediocrity?
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kingdrake2
11/25/19 5:14:35 PM
#28:


company had to protect profits....so they had to drop him.

thankfully car insurance can sometimes pay off (i'm all for it now) they covered my roommates full car cost but that lady's insurance probably skyrocketed.

she rammed into my roomates car through the front busting up the bumper and the engine area. damage was well over 3.7k damage.
it had to be scrapped.
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#29
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Balrog0
11/25/19 8:20:56 PM
#30:


Nall posted...
Fixed? I wouldnt say that. Better than what we currently have. There are major issues with our healthcare system that have hardly even been touched by either administration. I partly wonder if it has to do with how deep insurance companies pockets are and how influential they can be in Washington as a result.


In the narrow case of claims being denied for preexisting conditions it was fixed, though. No, health care writ large wasn't fixed, but this specific thing was.

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Esrac
11/25/19 8:24:30 PM
#31:


Man. So glad I don't need to rely on private insurance anymore.
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Solar_Crimson
11/25/19 8:24:53 PM
#32:


Crono99 posted...
As a canadian, I find this absolutely mind-boggling and terrifying.

How are americans okay with this?
The companies in charge have convinced both politicians and the public that affordable health care is socialism.

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rexcrk
11/25/19 8:36:06 PM
#33:


America! F*** YEAH!
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#34
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#35
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kingdrake2
11/25/19 8:51:47 PM
#36:


metallica846 posted...
[LFAQs-redacted-quote]



It's not like we are in here celebrating this shit. We tried to get out of it with the ACA and then the GOP gutted the whole damn thing immediately.


they had other plans :( first they repeal then they sit on their ass.
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Prismsblade
11/25/19 8:59:33 PM
#37:


Crono99 posted...
As a canadian, I find this absolutely mind-boggling and terrifying.

How are americans okay with this?
Becuase theres more to life then medicare, and Americans QoL even in lower classes are above and beyond most other 1st world countries in the world.

That and ultimately Americans are not willing to make the sacrifices to their QoL it would take to afford M4A.


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#38
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sktgamer_13dude
11/25/19 9:31:09 PM
#39:


Prismsblade posted...
[LFAQs-redacted-quote]

Becuase theres more to life then medicare, and Americans QoL even in lower classes are above and beyond most other 1st world countries in the world.

That and ultimately Americans are not willing to make the sacrifices to their QoL it would take to afford M4A.


Rich Americans and rich American companies dont want to make sacrifices.

Close tax loopholes and maybe theres some extra money in the budget.
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#40
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thronedfire2
11/25/19 9:38:08 PM
#41:


Thats pretty fucked up. So if I havent had insurance and get it they wont cover anything they find wrong with me when I get checked out?

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TheGleamEyes
11/25/19 10:13:10 PM
#42:


Balrog0 posted...
[LFAQs-redacted-quote]



In the narrow case of claims being denied for preexisting conditions it was fixed, though. No, health care writ large wasn't fixed, but this specific thing was.


Wrong.
https://www.federalregister.gov/documents/2016/10/31/2016-26162/excepted-benefits-lifetime-and-annual-limits-and-short-term-limited-duration-insurance

To address the issue of short-term, limited-duration insurance being sold as a type of primary coverage, the Departments proposed regulations to revise the definition of short-term, limited-duration insurance so that the coverage must be less than three months in duration, including any period for which the policy may be renewed. The proposed regulations also included a requirement that a notice must be prominently displayed in the contract and in any application materials provided in connection with enrollment in such coverage with the following language: THIS IS NOT QUALIFYING HEALTH COVERAGE (MINIMUM ESSENTIAL COVERAGE) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON'T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.
[...]
Some commenters requested that the Departments go further and prohibit issuers from offering short-term, limited-duration insurance to consumers who have previously purchased this type of coverage to prevent consumers from stringing together coverage under policies offered by the same or different issuers. However, in the Departments' view, such a restriction is not warranted. The individual shared responsibility provision of the Code,[17] which generally requires individuals to obtain minimum essential coverage in order to avoid an additional payment with their taxes, provides sufficient incentive to discourage consumers from purchasing multiple successive short-term, limited-duration insurance policies. The added notice requirement ensures that individuals purchasing such policies are aware of the individual shared responsibility requirement and its potential implications. Furthermore, such a prohibition would be difficult for State regulators to enforce, since prior coverage of a consumer would have to be tracked.


Notice the date. 2016. Meaning that for the entirety since ACA has been implemented, STI were still a thing, still being sold, and still being discussed on what action to take on them by stakeholders. Pre-existing conditions were addressed in insurance plans that qualified under the ACA as "Essential Coverages", but short term insurance remained outside the scope of having to accept pre-existing conditions
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Prismsblade
11/25/19 10:22:40 PM
#43:


metallica846 posted...
Honestly that's bullshit. American QOL won't go down if we continue to grow the debt. That number isn't even real anymore. Republicans talk about the debt, but when a president or govt tries to do something about it, they lose their fucking minds.

QOL would absolutely sky rocket with the cloud of bankruptcy lifted from joe shmo about his and his families health.
Not every citizen is having anxiety atks about medical insurance, or bill's. Im sorry for the many who are f***ed over. But aside from that generally Americans earning potential, opportunitys, benefits, and QoL are beyond most others in the world......Provided they dont make to many poor choices in life.

sktgamer_13dude posted...
Rich Americans and rich American companies dont want to make sacrifices.

Close tax loopholes and maybe theres some extra money in the budget.
Even if we took all their money and liquidated all their assets it wouldnt make a dent in our federal budget.


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Loud_Pipes
11/25/19 10:31:56 PM
#44:


Balrog0 posted...
In the narrow case of claims being denied for preexisting conditions it was fixed, though. No, health care writ large wasn't fixed, but this specific thing was.


That is still how the law is. I believe in this specific case the man signed up for short term insurance which doesn't have that stipulation in it. Otherwise people would sign up for it only when they're sick.
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Balrog0
11/25/19 10:35:01 PM
#45:


Loud_Pipes posted...
That is still how the law is. I believe in this specific case the man signed up for short term insurance which doesn't have that stipulation in it. Otherwise people would sign up for it only when they're sick.


Short term insurance plans that are essentially only allowed (and definitely only widely available) due to administrative actions by president trump.

The only reason to make a post like that is either sheer ignorance, a desire to shill for the administration, or both.

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Loud_Pipes
11/25/19 10:37:05 PM
#46:


Balrog0 posted...
Short term insurance plans that are essentially only allowed (and definitely only widely available) due to administrative actions by president trump.

The only reason to make a post like that is either sheer ignorance, a desire to shill for the administration, or both.


I'm pretty sure short term insurance plans never were covered by the law on pre-existing conditions. Correct me if I'm wrong.
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Balrog0
11/25/19 10:40:13 PM
#47:


TheGleamEyes posted...
Wrong.
https://www.federalregister.gov/documents/2016/10/31/2016-26162/excepted-benefits-lifetime-and-annual-limits-and-short-term-limited-duration-insurance

To address the issue of short-term, limited-duration insurance being sold as a type of primary coverage, the Departments proposed regulations to revise the definition of short-term, limited-duration insurance so that the coverage must be less than three months in duration, including any period for which the policy may be renewed. The proposed regulations also included a requirement that a notice must be prominently displayed in the contract and in any application materials provided in connection with enrollment in such coverage with the following language: THIS IS NOT QUALIFYING HEALTH COVERAGE (MINIMUM ESSENTIAL COVERAGE) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON'T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.
[...]
Some commenters requested that the Departments go further and prohibit issuers from offering short-term, limited-duration insurance to consumers who have previously purchased this type of coverage to prevent consumers from stringing together coverage under policies offered by the same or different issuers. However, in the Departments' view, such a restriction is not warranted.The individual shared responsibility provision of the Code,[17] which generally requires individuals to obtain minimum essential coverage in order to avoid an additional payment with their taxes, provides sufficient incentive to discourage consumers from purchasing multiple successive short-term, limited-duration insurance policies. The added notice requirement ensures that individuals purchasing such policies are aware of the individual shared responsibility requirement and its potential implications. Furthermore, such a prohibition would be difficult for State regulators to enforce, since prior coverage of a consumer would have to be tracked.

Notice the date. 2016. Meaning that for the entirety since ACA has been implemented, STI were still a thing, still being sold, and still being discussed on what action to take on them by stakeholders. Pre-existing conditions were addressed in insurance plans that qualified under the ACA as "Essential Coverages", but short term insurance remained outside the scope of having to accept pre-existing conditions


This is arguing that the individual mandate and it's penalty are sufficient incentives to prevent people from chaining together short term policies for long durations.

Not only did the TCJA get rid of the penalty, but the adminstration created rules expanding 'short term' coverage from 3 months to 364 days.

So this is evidence of how the administration has undermined the aca, you just need to understand the policies to follow it

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Balrog0
11/25/19 10:42:56 PM
#48:


Loud_Pipes posted...
I'm pretty sure short term insurance plans never were covered by the law on pre-existing conditions. Correct me if I'm wrong.


No, short term plans just used to apply to plans that were 3 months in duration, rather than competing directly with actual insurance by being literally one day shorter

Imagine wanting to carry water for trump so bad you'd just argue whatever industry talking point was popular. I at least respect libertarians that would just write this dude off entirely as an inefficient waste, that's a stance with principle even if it's deeply flawed morally

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TheGleamEyes
11/25/19 10:51:48 PM
#49:


Balrog0 posted...

This is arguing that the individual mandate and it's penalty are sufficient incentives to prevent people from chaining together short term policies for long durations.


Which meant that people could still sign up for STI ~5 years after ACA was signed into law.

Not only did the TCJA get rid of the penalty, but the adminstration created rules expanding 'short term' coverage from 3 months to 364 days.

So this is evidence of how the administration has undermined the aca, you just need to understand the policies to follow it


No, you've just provided evidence of how the administration (via TCJA) changed STI. Folks can still select "Essential" coverage plans if they were willing to shell out more for those benefits.
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Loud_Pipes
11/25/19 10:54:25 PM
#50:


Balrog0 posted...
No, short term plans just used to apply to plans that were 3 months in duration, rather than competing directly with actual insurance by being literally one day shorter

Imagine wanting to carry water for trump so bad you'd just argue whatever industry talking point was popular. I at least respect libertarians that would just write this dude off entirely as an inefficient waste, that's a stance with principle even if it's deeply flawed morally


Calm the fuck down, I'm not married to any particular view. I'm just pointing out that you were wrong. Short term plans have never to my knowledge been affected by the pre-existing conditions law. I'm not saying that what happened here is good or should ever happen again.

And I'm gonna need a source that shows what you're talking about wrt short term plans that are just a day shorter than regular plans. The ones I've seen and purchased were for a handful of months, not for a year.
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Balrog0
11/25/19 10:56:33 PM
#51:


TheGleamEyes posted...
Which meant that people could still sign up for STI ~5 years after ACA was signed into law.

No, you've just provided evidence of how the administration (via TCJA) changed STI. Folks can still select "Essential" coverage plans if they were willing to shell out more for those benefits.


It's actually an example of how the administration and the legislature have changed the ACA overall to undermine the entire argument for why STI should be allowed by your own source. It is true if you try to isolate specific parts of what you shared you can minimize how meaningful that is.

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