The answer is, without a doubt, a resounding Yes. Whatever the collective merits of the Patient Protection and Affordable Care Act, signed into law by President Obama on March 23, its impact on eating disorder treatment for children and young adults promises to be highly significant, and overwhelmingly positive. [For the record, Kartini Clinic has been a vocal proponent of healthcare reform; we don’t think this Act will solve every problem – in fact it may cause some of its own – but on balance we believe it to be an essential first step towards much needed comprehensive reform. And we sincerely hope the next round of reforms can be enacted without all of the political theater and hyperbole, not to mention hyperventilation!]
Why are we so optimistic? For the simply reason that a significant portion of the legislative reforms contained in this Act impacts the health care of children. And better still, such changes will be among the first to be implemented. This is clearly excellent news for our patients and their families.
The following are some examples of changes that will directly impact families seeking, or attempting to continue, eating disorder treatment for their children. For these points we are grateful to the Insurance Division of the State or Oregon, and their excellent web site.
Pre-Existing Conditions
President Obama and Congress have made it clear that, starting Sept. 23, 2010, insurance companies must accept all children under age 19 who apply, regardless of health, and immediately cover pre-existing conditions. If the Act does nothing else, this alone will do much to improve the lives of millions of young children with eating disorders. For the first time federal law offers protection to tens of thousands of hardworking families across the country who are looking for insurance for their critically ill children. It should be remembered that previously, families without access to group insurance through an employer could not get coverage for a children with a pre-existing condition at any price. And most will still not get it for free, but they will have the chance to purchase some protection against personal bankruptcy resulting from uninsured medical bills.
Benefit Limits
For all existing and new health plans, federal law now prohibits insurance companies from placing a dollar limit on how much they will cover over the lifetime of a member. Typical health insurance policies now limit the value of lifetime benefits to $1 million to $2 million.
Policies may still have some annual limits on benefits until Jan. 1, 2014, but federal law will restrict how much plans can limit emergency services, hospitalization, maternity, and some other “essential” health benefits. The Health and Human Services secretary will define these restrictions. This restriction on annual limits applies to all plans except for existing individual plans.
Dependent Coverage
Adult children who are on their parents’ plan now but who lose that coverage when they graduate from college can rejoin their parents’ policy whenever their plan renews, after Sept. 23, 2010. Starting in 2014 all children up to age 26 can stay on their parents’ employer plan even if they can get coverage through their own employer. Both married and unmarried children qualify for this dependent coverage.
It is essential that you speak with your insurance company and your employer (if you have coverage through your job) today about the renewal date for your policy. Knowing and understanding your rights could make all the difference in receiving essential health care for your child.
