posted
Will this have an effect on insurance coverage for Lyme disease as prescribed by the new International Lyme and Associated Disease Society (ILADS) Lyme disease treatment guidelines, which meet the federal DOH definition of a “medically accepted standard of care”? Should Lyme advocates push for insurance coverage of Lyme disease treatment to be included in this federal investigation?
KarlaL
Obama Administration to Investigate Insurers for Bias Against Costly Conditions New York Times By ROBERT PEAR DEC. 22, 2014
WASHINGTON — The Obama administration said Monday that it would investigate prescription drug coverage and other benefits offered by health insurance companies to see if they discriminated against people with AIDS, mental illness, diabetes or other costly chronic conditions.
The administration said it had become aware of “discriminatory benefit designs” that discouraged people from enrolling because of age or medical condition.
In a letter to insurers, administration officials said that a health plan could be engaging in unlawful discrimination if its list of approved drugs excluded all medicines needed to treat a particular condition, or if it restricted access to such drugs by charging large co-payments or requiring prior authorization.
The Centers for Medicare and Medicaid Services said it would focus on companies in the federal insurance marketplace. For each health plan, it said, it will try to determine the “estimated out-of-pocket costs associated with standard treatment protocols for specific medical conditions using nationally recognized clinical guidelines.” The conditions, it said, are likely to include bipolar disorder, diabetes, H.I.V., rheumatoid arthritis and schizophrenia.
The Affordable Care Act says that insurers must accept all applicants for coverage and cannot charge higher premiums because of a person’s pre-existing conditions or disabilities. Advocates for people with H.I.V./AIDS and certain other illnesses have complained that insurers were unduly limiting access to benefits. . . .
-------------------- KarlaL Posts: 694 | From New Lebanon, NY | Registered: Dec 2010
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
Well, it would be nice if they would also clean house inside the government too, starting with the CDC and NIH, who have completely failed with lyme. Would be interesting/shocking to see how much morbidity and mortality they are responible for. You know the CDC puts out their MMWR. That stands for Morbidity and Mortality Weekly Report. Now they just need to isolate the numbers they themselves have caused.
Posts: 2888 | From USA | Registered: Mar 2004
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Razzle
Frequent Contributor (1K+ posts)
Member # 30398
posted
They should also include Asthma. There are no generic Asthma inhalers (rescue or steroid), therefore most insurances won't cover much (if any) of the cost of treating Asthma with rescue + steroid inhalers (the traditional standard of care for Asthma).
-------------------- -Razzle Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs. Posts: 4166 | From WA | Registered: Feb 2011
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