Boris
Beach Bum
Not necessarily...the only thing that changed was the person paying the premium. The coverage was always minimal lowest tier.yes, but the link I provided says or implies that the grandfathered plans cannot change materially the coverages provided after the grandfathering date. Since these changes went into effect, as Terry explained, after the ACA passed, I don't see how they can be legal. I would definitely file a complaint with whatever governmental organization is interested in this sort of thing.
FWIW, the plan I have right now as my medicare supplement, also offers a three tiered plan for disabled and furloughed railroad employees,(whose COBRA has expired). The non medicare portion still doesn't incorporate some provisions available under ACA sanctioned plans, (and also has lower premium costs than the average ACA sanctioned plan in NJ for example). There are numerous exceptions to ACA...that's how ACA survived.
The real problem, (I believe), that Terry experienced was the way his blood work claim was coded. Screenings generally are not covered unless under government mandate. When these tests are covered under "Medical Necessity", they get paid. What it all comes down to is Terrys Statement of Coverage, and limitation of coverage prevails.
