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I was recently told by my insurance broker that if Obamacare takes effect, expensive treatment such as Faslodex, Zometa will not be covered for older patients.

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  • sandybiest
    sandybiest Member Posts: 12
    edited March 2012

    I was recently told by my insurance broker that when and if Obamacare is implemented expensive treatments such as faslodex and zometa will not be covered for older patients who are stage iv/

  • peggy_j
    peggy_j Member Posts: 1,700
    edited March 2012

    The Health Care Act of 2010 has many parts that will take effect over time. Some are already in effect. Did the person have more specific info including the source? I know some people have spread bad rumors about these changes (remember the claims of death panels?) This might be another one of those rumors or...maybe your contact can provide more info?

  • fairweather9
    fairweather9 Member Posts: 76
    edited March 2012

    I started zometa 4 months ago and remember my doctor had to check and see if my insurance company would cover it before the first treatment, nothing to do with age just weather or not they would pay for it.  So it kind of sounds like one of those rumors Peggy is talking about.

  • sandybiest
    sandybiest Member Posts: 12
    edited March 2012

    This information was provided by an insurance broker.  It will only apply to older patients as some in this administration don't believe they are worth treating. 

  • pupmom
    pupmom Member Posts: 5,068
    edited March 2012

    This is rightwing propaganda, pure and simple.

  • jennifer1
    jennifer1 Member Posts: 185
    edited March 2012

    Amen, yorkiemom,

  • Gingerbrew
    Gingerbrew Member Posts: 2,859
    edited March 2012

    Insurance brokers are just that brokers. They have no special insight into government programs. They are sales people.  

    It is indeed propaganda. 

  • susan_02143
    susan_02143 Member Posts: 7,209
    edited March 2012

    There is no such thing as ObamaCare. There is the Health Care Act 2010 which was voted into law by the full body of congress and then signed by the President Obama.

    Insurance brokers are one step up from used car salesman. Enough said. 

  • Mallory107
    Mallory107 Member Posts: 223
    edited March 2012

    moderators-obviously there is no room for intellegint discourse on the "Health Care Act' by members of this community...even though its' full rollout will directly affect ALL of us.  I would remove this post if I were you because its not fair to those of us who CAN speak about this without namecalling.

  • Gingerbrew
    Gingerbrew Member Posts: 2,859
    edited March 2012

    I don't understand, who is name calling?

  • Enjoyful
    Enjoyful Member Posts: 3,591
    edited March 2012

    There are many misconceptions about the Health Care Act.  I've read the entire bill, as passed, and there are no death panels nor are older patients denied medication.

  • Anonymous
    Anonymous Member Posts: 1,376
    edited March 2012

    The bill was passed well over a year ago, and we still don't really know what will and will not be covered.  No one in or out of government can or will tell us. 

    The current attempt to force religious institutions to cover birth control even if it is in opposition to basic tenets of that religion is part of the implementation.  That seems likely to be decided by the Supreme Court eventually unless the provision is dropped before it gets to that point.  Freedom of Religion is specifically guaranteed in the Constitution, "free" birth control is not.  If the provision is allowed to be enforced, all Americans will be the losers, of something very important.

    There is a provision in the law to have a panel or committee decide if the cost to benefit ratio of specific treatments will allow them to be covered.  Many insurance companies have similar groups now, but if someone is denied coverage by an insurance company, there are other options, including government intervention.  If the government is the entity doing the denying, who will people appeal the decision to?

    No matter what you call it, for some people who are older, or very sick and whose only treatment options are expensive, they will function as death panels because if they deny one person treatment and that person dies, that panel has contributed to that death.

  • YramAL
    YramAL Member Posts: 1,651
    edited March 2012

    I thought we weren't supposed to have political discussions on this board. It seems to me the very act of calling it "Obamacare" instead of the Health Care Act is inflammatory. 

  • Mallory107
    Mallory107 Member Posts: 223
    edited March 2012

    I agree there are many misconceptions...particularly about the 'death panels.'  Not sure most people know what they really mean but here is an example:

    The federal government has pro-actively decided to take Avastin off label for BC treament.  This is in foresight to the coming years when the governement will have to pay for this hugely expensive treament.  Rather than absorb this huge cost to the governemnt they have decided to take it away.  As this drug can save lives I would call this action a death-panel verdict:  A decision by the government about who should live and who should not based on efficiencies. 

    I believe that this will be the first of many instances where we will see effective but costly medication taken off the table in even life and death situations. 

  • YramAL
    YramAL Member Posts: 1,651
    edited March 2012

    Insurance companies already make these life or death decisions, don't they? I've read story after story on here of treatments and prescriptions being denied by insurance companies. But I guess that's OK because it's private companies.

  • Anonymous
    Anonymous Member Posts: 1,376
    edited March 2012

    The difference is that if a private company denies a treatment, there are avenues of appeal, and there are alternative sources for obtaining the treatment.  If the government is the sole arbiter, and decides that a treatment won't be available, they remove the alternative sources.

  • pupmom
    pupmom Member Posts: 5,068
    edited March 2012

    Best thing that could happen to this country would be single payer national health care. HCA 2010 is a timid start. Hope it evolves into true national health care. Once people realize they don't have to worry about going bankrupt from a health care crisis, or dying because they can't afford basic preventative care they won't want to go back to the dark ages of health care for profit, of the few.

  • Mallory107
    Mallory107 Member Posts: 223
    edited March 2012

    Yes, it is OK because it is private and so therefore there are other companies to go with.  Under federal healthcare there will NOT be options.  Especially down the line when all private companies give up offering insurance to their employees in lieu of the public plan( and MANY of them have divulged that this will indeed happen).  And one more thing-if it was such a good plan then why doesn't Congress have to go on it?  Or the unions?  Or any other big company that can buy/lobby their way out of it?  THe only reason that I am not completely terrified of this is because it is illegal and I have high hopes that justice will prevail when the SC gets the case.  IF you really want to see into our future with this plan look at some of the posts from girls in other countries-particularly the UK. 

    And now I revert back to my original request that these political discussions not be allowed here.  Oh, and the namecalling....'rightwing' propaganda comes to mind.  Just like many are offended by the term Obamacare there are many offended by that just so you know. 

  • MariannaLaFrance
    MariannaLaFrance Member Posts: 777
    edited March 2012

    I don't purport to have read the Health Care Act, but have had some experience in porting over to the new 5010 regulations on EDI and billing practices. I found this article, and it seems to do a good job on reporting on what happens to some of our Medicare costs for those who currently receive Medicare. This is where seniors might lose what they currently have. For what it's worth, here is an article that attempts to explain the bill.

    BTW, the bill is over 1,000 pages long.

    http://www.csmonitor.com/USA/Politics/2010/0322/Health-care-reform-bill-101-What-does-it-mean-for-seniors 

  • MariannaLaFrance
    MariannaLaFrance Member Posts: 777
    edited March 2012

    Oh, and here's a copy of the bill for those of you who like scintillating reading to keep yourself awake at night.

    http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf 

  • Wabbit
    Wabbit Member Posts: 1,592
    edited March 2012

    notself has posted the official implementation schedule of the provisions of the Affordable Care Act on this forum.  No hype or fear mongering ... just the facts for those who are interested.

    There have been several discussions about the Avastin decision on this board.  It was taken off schedule for use for breast cancer because of scientific studies that showed it was not effective for this purpose and caused more harm than good.  This is the type of decision that has always been made about all drugs and can be argued on its merits.  But it has nothing to do with the Affordable Care Act.

    The current birth control coverage disagreement is IMO a case of competing rights.  The rights of an employer to deny benefits based on their religious beliefs vs the rights of their employees in a secular environment to not be discrimated against and denied coverage for medical needs due to the religious beliefs of someone else (their employer).   There is already an exemption for churches ... the question here is how far out into the secular business world (colleges, hospitals, etc.)  this should go. 

    There are religions that do not believe in blood transfusions for example but I have never heard of an employer of that religion who provides health insurance and has exempted coverage for that.   Birth control for women seems to be the only benefit anybody is fighting about.     

  • lago
    lago Member Posts: 17,186
    edited March 2012

    Amen yorkiemom. As long as health insurance is a for profit industry this will always be a mess. It's amazing that we don't even know what our doctor, scan or treatment charge will be till we get the bill. That's nuts.

    a friend of mine went for her lumpectomy little over a year ago. They insisted she get a pregnacy test before they operate. She's divorced and hasn't had sex in 5  years. She had to fight to not take the test. She would have had to co-pay for that but she was obviously not pregnant. She was almost 49 at the time. Talk about wasting money.

    ------------------------------------------

    But back to the initial question. Your insurance broker is distorting the facts. There are already things that medicare won't pay for once you reach a certain age. I think after 80 they may not pay for colonoscopies.

  • Enjoyful
    Enjoyful Member Posts: 3,591
    edited March 2012

    Mallory -

    Competition among health care insurance sure is a good theory, but when you start talking about people with serious diseases the "free choice" aspect drops off.  What profit-minded insurance company would choose to insure a breast cancer patient?  Let's say you don't have a serious disease but you're thinking about the possibility.  If your employer-provided healthcare plan has coverage holes, what are you going to do?  Quit your job and look for another?  

    Our healthcare delivery system is ridiculously limited because of its link to employers.  We really don't have much freedom of choice and competition is limited.

    Mallory, you also refer to a "plan" and why the unions or members of Congress don't have to enroll.  To which plan do you refer?  The Health Care act isn't a health insurance plan, merely legislation intended to offer, through various avenues, insurance to everyone.

  • Enjoyful
    Enjoyful Member Posts: 3,591
    edited March 2012

    Thank you for posting a link to he bill, Marianna.  I'd urge you all to read it if you haven't already done so.

  • NatsFan
    NatsFan Member Posts: 3,745
    edited March 2012

    In response to Sandy's original post - I have never heard of any provision like this, and my guess is that if something like that was in the bill, the AARP would object strongly and publically.  I've heard nothing out of them and they're pretty savvy about legislation as it pertains to seniors.

    I'd ask your broker to give you the specific provision in the Health Care Act that has caused him concern.  If he's unable to point to specific provisions, then I'd be inclined to give his statements less credibility.  If he is able to point to one or more specific provisions that have caused him concern, then you can read the provisions for yourself and research them fully and come to your own conclusions.   

  • VJSL8
    VJSL8 Member Posts: 652
    edited March 2012

    http://www.cancer.org/MyACS/Eastern/AreaHighlights/affordable-care-act-six-ways

    The American Cancer Society has done extentive research into the Affordable Care Act, and while it's not perfect, it has definate benefits for cancer patients. ACS wouldn't endorse it if your claim was true. 

    I can't wait until 2014 because I have had the same insurance policy since 1987 and it sucks but no one else will cover me because of pre-existing conditions (I had cancer in 1987).  

  • Bren-2007
    Bren-2007 Member Posts: 6,241
    edited March 2012

    Natsfan .. your note makes sense to me.  If the insurance broker can't point to a specific line in the Health Care Act, I would consider it to be a rumor with  no validation.

    Bren

  • Wabbit
    Wabbit Member Posts: 1,592
    edited March 2012

    Mallory ... Under the ACA there is not one 'public plan'.  There is a pool of differing plans ... offered by different companies ... from which to choose.

    It is modeled after the Federal Employees Health Benefit Program which I happen to be under (as is Congress).  All must meet minimum standards but are free to offer more than that.   They will not be allowed to refuse coverage based on pre-existing conditions anymore either.  It will be administered by OPM just like the FEHBP.  So actually Congress is already on basically the same system.  And if employers decide to quit offering health insurance and provide their employees with $$$ to apply to the plan they select under the ACA it will be exactly like what government employees and Congress now has. 

    I am very glad that I have been able to select a plan in this manner and decide for myself how much coverage I need and how much I am willing to pay for it ... rather than have an employer decide for me in a 'take it or leave it' manner like many do.   I think many people who are so very against the whole idea will be pleasantly surprised when it is implemented. 

  • MariannaLaFrance
    MariannaLaFrance Member Posts: 777
    edited March 2012

    VJSL8, interesting that no one would cover you. I just changed jobs, and my husband insisted that I carry the health insurance. I was so reluctant to apply out of fear. I haven't seen our insurance cards come to our house yet, but am waiting impatiently to see if they refuse to cover me. I sure hope they don't, because my husband's position is being eliminated in 8 months, and we'll be relying on my insurance coverage for the family.

  • Enjoyful
    Enjoyful Member Posts: 3,591
    edited March 2012

    How nice to see you again, Sherri!  I hope you've been well.

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