Thursday, August 18, 2011

The Affordable Care Act: Info on PCIP (And Some Whoop Ass Thunder Rumble!)

The article below this garbled prologue was written by the good folks at PCIP.  I can attest to its accuracy, having purchased this coverage beginning with its very first month of availability in July 2010.

If I could add anything, it would be to plead with people who feel a responsibility to accuracy to understand that the PCIP program is in no way a charity or an entitlement, and that it is run in an admirable "tight-ship" sort of way under the auspices of GEHA.  My premium has been lowered TWICE since July 2010.  It started out at well over $400/month and is now $338/month.

I have even drooled with appreciation at my exposure to actual customer-oriented customer service representatives, each of whom quickly and efficiently answered my questions and cut through the inevitable red tape of a brand new insurance program.  It helps, I'd assert, that the precepts under which these customer service types work make efficiency easy, as a common sense of fairness seems to be the guiding principle.

Why *yes*, the ACA was created by mostly the same idiots we watched screw the pooch a few weeks ago in their criminal attack on The World Economy.

Screw the pooch is a particularly vile militaristic expression, popularized by Tom Wolfe in the novel, and subsequent film, The Right Stuff:

But now - surely! - it was so obvious! Grissom had just screwed the pooch! In flight tests, if you did something that stupid, if you destroyed a major prototype through some lame-brain mistake such as hitting the wrong button - you were through! You'd be lucky to end up in Flight Engineering. Oh, it was obvious to everybody at Edwards [Air Force Base] that Grissom had just f*cked it, screwed the pooch, that was all.

For those of you fascinated by my constant dabbling in dirt, I did some research and it turns out that the  original form of screw the pooch was fuck the dog.

Umm, also integral to your understanding of the Affordable Care Act, Obamacare, is the distinction between screw the pooch and fucking the duck, though one might be considered the governmental correlative of the other. You'll see this explained in the commentary to the pertinent Jennifer's History and Stuff blog post:
Custer screwed the poochWasting time is another quite profane term. It's 'fucking the duck'. There is, or was, a difference. Nobody buys the farm from fuckin' the duck.
Well, not so.  Had President Obama fucked the duck and given up on any meaningful health care reform legislation, thereby effectively screwing the pooch,  I would likely have bought the farm, as a result.

I'm just sayin'.

And, of course, on to what *really* matters, which would be my actual reference underlying that trite and overwrought "The World Economy" nonsense: the completely undeserved assault-and-battery on Haddock family equities! The Haddocks, they ARE the world!  I mean, if no one takes care of the Haddocks, how will The Captain take care of me and Fred, as well as tend to the upkeep of the miniature Wimbledon All English Lawn Tennis Clubbery? Not to mention seeing to the hygiene of the garderobes of Marlinspike Hall, so necessary to the success of ManorFest?  Infrastructure, people, infrastructure!  Oh, God, just the thought of next year's percolating strains of moat algae...




{hum, hum, hum}

What? Oh.  Right!

To prove my assertion that Obamacare is not Welfare, here's a screen capture of the details of what *I* have paid out in deductible, co-pay, and out-of-pocket expenses (NOT including pharmacy costs).  So the next time someone yammers about "socialism" and "entitlement" in reference to the watered-down health care bill that the President spearheaded, refer them to my actual costs.

What is it, then, if it isn't some welfare "ripoff" perpetrated by a bunch of whiners?  It's FAIR.  My costs are exorbitant -- not so much this year as in the past three when we were actively attempting to stop the infection in my joints and long bones, but still, they are higher than most people's average medical expenditures.  The difference is not some sense that I am deserving or "entitled," no!  The difference is that I am actively *sick* and also deal with severe disabilities and pain brought on by a progressive neurological disorder -- to such an extent that when I was priced out of my private BCBS coverage, no one would offer me a policy.  That's the foundational requirement for eligibility in PCIP -- to have been so rejected!







Medical plan detail

Close window



In network
deductible
Out of network
deductible
In network
out of pocket
Out of network
out of pocket
Current medical plan limits$2000.00$3000.00$5950.00$7000.00
Accumulated to date$2000.00$2098.88$5950.00$2199.22




BCBS of Tête de Hergé ended up raising my premium three times in 2009, and finally demanded $1513/month, with a $5000 deductible.  They had also begun to refuse to pay for services that were clearly covered, dragging their feet and making my tending hospitals and physicians request payment many times before moving on to some other delay tactic.

One of my favorites, as well as least-mentioned around here, because it renders me unusually apoplectic, was their assertion that I received not one, but two (and a year apart) policy booklets that had an unfortunate misprint.  That misprint concerned the lifetime cap to my coverage.  My two, year-apart copies both said $5,000,000.  BCBS said, "Au contraire, ma chère!  That was supposed to be $2,000,000." They also scoffed -- in writing, if you can believe their hubris -- at my concern about it, saying that most people wouldn't even have an issue about it, as most people don't max out of 2 million in coverage (negotiated coverage, at that!).  Well, of course, I did.  Max out, that is.  They really do count on us being total hebephrenics.  They do not anticipate things like me turning it all over to the Tête de Hergé Insurance Commissioner... who promptly collected a whole bunch o' "misprinted" policy manuals, including many in their own holdings.

Towanda!

But though they'd lose an occasional battle ("Corporations are people!"), BCBS won the war.  It was highly stressful for all concerned.  It did not exactly improve my health to go a year without coverage, during which time I lost a lot of ground trying to stomp out osteomyelitis. Self pay the $2000+ monthly pharmacy costs for daily meds?  Not likely! Self pay for six weeks of intravenous vanco?  Ya think?  Self pay for removal of a prosthesis and implantation of an antibiotic-laced spacer?  Really?

So... FAIR, to me, is right.  FAIR, to me, is good.  If you must beg to differ, let me know.  We'll talk about it.  Personally, I was profoundly disappointed in the ACA, as the only truly just legislation would have included a "public option."  [Now you may throw words at me!]  To thoroughly confuse you, so long as this country follows the confusion of corporate models with a belief in personal liberty? I am pissed at the people who refuse to pay for coverage but want me to make their health a priority. Who whine and whine about it but don't consider turning off their internet, television, or phone -- who don't move to a more affordable living space -- who consider abusing emergency room services their righteously righteous right, who will pay through the nose for vet services but not "people" assistance. Who eat out on a regular basis, who pay for cigarettes, who put drugs up their nose and in their veins, alcohol in their stomachs and livers, but don't think twice about channeling all that money into health care.  I don't understand people who will not live within their means and are willing to drag others down with them -- children, grandchildren, spouses, live-in lovers -- and us, their neighbors, who end up footing their bills and seeing our own go up as a result.

What truly devastates me?  Watching the mindset passed on to successive generations, watching the belief in the possibility of a better life get actively squashed as a result of a hundred daily decisions to do what is easiest but not best.

Anyway.

Before you have a cow thinking I've betrayed my socialist beliefs -- I've not.  See my original assumption which begins "[t]o thoroughly confuse you, so long as..."  I want that assumption/assertion to change.  But so long as I am stuffed into this ridiculous box of USAmerican denial, yeah, I'm going to go all right wing on your uninsured asses.  Snort!

What's that?  You would if you had a job?  You would if there actually were affordable housing?
My point, exactly.

So "gentle butterfly hugs" all around!  Shazam! [Which is, according to the democratic Wikipedia,  "onomatopoeia for thunder rumble."]


Thunder Rumble!

Please pass this info on to anyone you know who might benefit from it. Thanks!

[If you don't think such people exist in your sphere, well, Towandasnort, shazam, and thunder rumble.]


***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ 

PCIP offers health coverage, even if you have a pre-existing condition
Many people who have been unable to get health insurance can now get coverage through
the Pre-Existing Condition Insurance Plan (PCIP), created under the Affordable Care Act.
PCIP is provided through the U.S. Department of Health and Human Services and
administered by the Office of Personnel Management through GEHA in more than 20
states.

Choose the plan that fits your needs
PCIP has been improved for 2011, with better premiums, better benefits and a greater
choice of plan options. PCIP enrollees can now choose from three plan options, with
different levels of premiums, calendar year deductibles and prescription copayments. The
HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt
account where you can deposit funds for eligible medical expenses.

Each of the three PCIP plan options provides preventive care (paid at 100%, with no
deductible) when you see an in-network doctor and the doctor indicates a preventive
diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer
screenings. For other care, you will pay a deductible before PCIP pays for your health care
and prescriptions. After you pay the deductible, you will pay 20% of medical costs innetwork.
The maximum you will pay out-of-pocket for covered services in a calendar year is
$5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the
amount the plan pays for your care.

Each of the three PCIP plan options:

Includes all covered benefits, even to treat a pre-existing condition, immediately from
the date coverage begins.

Covers a broad range of health benefits, including primary and specialty care,
hospital care and prescription drugs.

Does not charge a higher premium to individuals with medical conditions.

Does not base eligibility on income.

Are you eligible?
To be eligible for the Pre-Existing Condition Insurance Plan, you must be a citizen or
national of the United States or residing in the U.S. legally, have been uninsured for at least
the last six months, and have a pre-existing condition or have been denied coverage
because of your health condition.

Want more information?
Health care options in all states: www.healthcare.gov
PCIP administered by GEHA: www.pciplan.com, (800) 220-7898
To apply for the Pre-Existing Condition Insurance Plan: (866) 717-5826

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