The recent healthcare reform legislation is supposed to put an end to lifetime caps on health insurance benefits beginning in September of this year but health insurance companies are alleging a loophole that they believe allows them to continue the caps for up to another year.
- Possible loophole in health reform found
- An additional year of caps may be in the works.
Health insurance companies need to stop delaying the end of lifetime caps. After fighting long and hard to ensure the passage of health reform we are outraged that people with disabilities and chronic conditions have to wait another year to reap its benefits. Hasn’t this community suffered enough? We intend to do everything in our power to ensure lifetime caps are put to bed this year, not next.
Healthcare reform is intended to prohibit health insurance companies from imposing lifetime limits on benefits to be paid. Limits of $1 million have been common. This seems like a lot of money – but people living with severe spinal cord or brain injuries and other serious injuries or chronic conditions, including hemophilia – often exceed these lifetime caps. Why? These types of cases require special care and advanced medical treatments to successfully improve patient outcomes. You can’t simply send a person with a spinal cord injury or disorder home with a prescription and tell them to call you in the morning. There are a multitude of symptoms (too many to list here) that people with spinal cord injuries and disorders may experience, and unlike the general patient population, a minor medical issue can turn into something much more serious and life-threatening very quickly without the proper treatment strategy.
Now regarding the possible one-year loophole; Under the new healthcare reform law, all new health insurance plans and grandfathered health insurance plans (i.e., health insurance plans that were already in effect before health reform passed) have to eliminate lifetime caps by the end of September. Some health insurance companies are saying their interpretation of the law is that they do not have to remove the lifetime cap on benefits until the start of the new plan year. As we have already stated, this could extend the elimination of lifetime caps for several months to possibly a year.
While a delay would not affect the majority of the population, it WILL impact some people who have high health care costs due to catastrophic injuries, including spinal cord injuries – which are often accompanied by other multiple injuries or chronic conditions. Extending lifetime caps for another year will put many lives in jeopardy.
We have joined other national groups in sending a message to the Health and Human Services Secretary to clarify the intent of the law that lifetime caps on health insurance should end in September.
