Wednesday, February 9, 2011

Health Care Reform My Left Foot

I just got a letter from my HMO. I effectively have no coverage for prescriptions. Most of my medical cost is prescriptions. I am full of rage, and lack the words to articulate said rage. Thank you Health Care Reform.

Letter as follows:

The Affordable Care Act prohibits health plans from applying arbitrary dollar limits for coverage for key benefits. This year, if a plan applies a dollar limit on the coverage it provides for key benefits in a year, that limit must be at least $750,000.

Your health insurance coverage, offered by Aetna Life Insurance Company, does not meet the minimum standards required by the Affordable Care Aft described above. Instead, it puts a coverage year limit of:

Most this plan will pay per month for prescriptions $35

Benefits stated below are paid per coverage year and held to the Usual and Customary Charges.
Out of Area Benefits are paid the same as In Network Benefits under this Plan.
In network deductible: $100
Out of network deductible: $200
Plan pays in network expenses at: 80%
Plan pays out of network expenses at: 60%
Maximum Benefit paid: $10000
Coverage Year Maximums applied to the Maximum Benefit stated above:
Outpatient Expenses limited to: $1000
Emergency Room Expenses limited to: $600
(applies to the Outpatient Expenses limit)
Hospital Services (other than Room & Board) limited to: $1000
Outpatient Office Visits:
$15 per visit copay/base deductible (in or out of network)
In network visits are paid at 100%; out of network at 50%.
Outpatient office visits are subject to the outpatient expense coverage year limit of $1000 and the $10000 coverage year Maximum Benefits.
Wellness Benefit:
$15 per visit to an in network provider
Plan pays 100% for an in network/50% for out of network
Coverage Year Maximum: $200

In order to apply the lower limites described above, your health plan requested a waiver of the requirement that coverage for key benefits be at least $750000 in coverage for key benefits this year would result in a significant increase in your premiums or a significant decrease in your access to benefits. This waiver is valid for one year.

If the lower limits are a concern, there may be other options for health care coverage available to you and your family members. For more information, to to:

If you have any questions or concerns about this notice, contact (MY PLAN) at (THEIR NUMBER).

Some states offer a Consumer Assistance Program to help you better understand your health care coverage options. For more information, please go to:

I pay $60 every two weeks, for this coverage. A reasonable rate for what the plan used to be. It used to cover way more prescription costs. I don't have the info handy on what that used to be.


  1. HR or whoever handles your benefits should be able to get you that information. My company posts links for comparison purposes during the decision window. Yours probably does, too. It should be a simple matter for them to give you that link, or the information in printed form.

  2. That sucks, I'm sorry. Get informed and you can be a proponent of change!


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I'm Rory or Rorek in most places. I design, sew, and craft, primarily for my Asian Ball-Jointed Dolls. I also dabble in interior design, but I'm a little out of practice.

I post about the things I enjoy, which are sewing, photographing my dolls, designing new outfits, knitting, which I started in September of 2008, thanks to my Mom, and occasionally drawing, or painting.

I also post about Life Events and how they affect me and those that I love.

Currently I am living in DFW, Texas in the USA and working towards a degree in Theology.