<p>That’s what I keep telling them. She needs coverage on Jan 1st. I am aware of the March deadline for penalties. I was just taken aback that the marketplace rep actually brought up that D didn’t need to worry about any penalties, and suggested taking the screen shot. I didn’t bring up the prospect of penalties, she did. </p>
<p>If, after spending a ridiculous number of hours trying to navigate this sorry excuse for a website, and finally actually getting the darn app submitted, they had the audacity to fine D when their system is the sole problem here, … it’s just too ridiculous to even contemplate.</p>
<p>So now HHS is “suggesting” that insurance companies cover people Jan 1, even if they haven’t paid their premiums. And, cover out-of-network charges, even if the docs aren’t on the plan the customer has bought. And, cover refills in January, even if the policy doesn’t cover them.</p>
<p>One wonders what exactly “suggesting” means when the federal government does it? “My that’s a lovely insurance company you’ve got there. It would be a shame if something happens to it…”</p>
<p>Got a Season’s Greetings card from a libertarian think tank. The message inside? “Under our proposal, if you like your holiday plan, you can keep your holiday plan. Period.” :)</p>
<p>Probably the best card I’ll get this year.</p>
<p>Re Prescription Drug Step Therapy: At one point I had to take some pretty heavy doses of prescription NSAIDS for a number of years. My (original) doctor started me on something cheap, but I had unacceptable side effects, so we went on to the next drug, which didn’t have side effects, but which didn’t work for me. Then I changed doctors. And tried a third drug, which had side effects. And finally, onto a fourth. Which was expensive, but which worked and which didn’t have side effects that were unacceptable. About a year later, the insurance company imposed pre-authorization requirements for the (expensive) drug I was taking, and it was a good thing that I had my OWN copy of the original doctor’s records because my current doctor couldn’t find that drug history in the file, and the original doctor had closed his practice and moved out-of-state. </p>
<p>Dealing with insurance companies is death by a thousand paper cuts, but if you gather and keep your documents, the path is easier. My doc still had to get on the horn to justify the expensive drug, but the proof that I’d tried several different classes of less expensive NSAIDS was important, and I was approved.</p>
<p>I think that working my way up to the expensive drug was completely reasonable. I’d have been happy if one of the cheaper ones had worked without side effects. Lots of doctors (then, not so much now, I guess) typically started patients on the expensive brand name drugs – often with a free starter supply – and so I get why insurance companies are pushing people to go through step therapy now. </p>
<p>(And this was pre-ACA, so not due to Obamacare.)</p>
<p>Realistically, the chance of penalties being enforced this year???</p>
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<p>Unfortunately for Sebellius, the state insurance commissioners may have a lot more sway. (In the case my state, I’m guessing the state exchange, Covered California makes those calls.)</p>
<p>My daughter had a mri and got an all clear today. No evidence of a tumor. Oncologist doesnt think the tumor is coming back. </p>
<p>I can fly today. :)</p>
<p>I had a great talk with her about different pricing between self insurance, stop loss plans and
Insurance companies but I didnt understand half the stuff she said. :)</p>
<p>That is awesome dstark. I can’t even imagine dealing with that kind of stress and fear. I get upset when one of my kids scrapes his knee. That’s got to be a huge relief!</p>
<p>I know many posters and readers of CC are going through some difficult times. My heart goes out to you.</p>
<p>I hope that everybody has a happy, fun, healthy new year.</p>
<p>My daughter’s oncologist works in Redwood City about an hour from where I live. The oncologist lives across a park from me. I look directly at his house. I could throw a
baseball and hit his house. At least, I used to be able to throw a ball that far. :)</p>