A person has major surgery, and meets their out of pocket maximum while in the hospital. Upon discharge, they bring a prescription to the pharmacy for a continuation of care medication, say for example injectable Lovenox. This is often given after a stent is put in, for example, to prevent clotting, and is cash priced at over $1000 (even for the generic which is now available.)
In this case, the person should be able to get their prescription for the copay price.
However, because there exists no mechanism for the pharmacy benefits manager to "talk" to the medical claims administrator within the ACA, the copay given to the pharmacy when the claim is submitted will be the full cash price. There will be absolutely no way for the pharmacy to know the out of pocket maximum has been met.
Within this addendum to the 40,000+ pages of regulations, in this one small FAQ, the Dept of Labor/HHS/Treasury all admit "These processes will need to be coordinated under section 1302(c)(1)."
Obviously from watching the healthcare.gov website, the integration of legacy systems of data is a huge task. After they get that website working, how much will this one small process cost us, the taxpayer, to implement. Is it even possible?
***I've never posted before, and I can't tell if I am doing it right. Please edit as needed. I'm just throwing this out there because it will really affect me in my line of work. Thanks!***
Medical Doctor: "That's what we say about a stool sample."
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I think we knew from day one this was a “full employment” bill for attorneys. Even over and above the 15,000 lawyers and accountants hired by the IRS to administer/enforce Obamacare.
Toast.....They are trying to baffle us with bullshiie.
Great post, you done good.......even though the info is disturbing :(
“and a separate managed behavioral health organization”
Probably off topic. But what the hell is that?
The phrase reads as if somebody is trying to regulate socialism in order to claim they are defending freedom in the marketplace. The only problem is that it creates more bureaucracy instead of promoting liberty.
I wasn't born in the USA to be a stinking slave.
I'll always be a free man 'til they put me in my grave.
Filling out your forms is just a giant hose!
I'll have to change my address and hide my assets I suppose.
Your Progressive commie paradise I'll have to leave behind,
and if you try to follow me I won't be very kind.
Loading my magazines. Loading my magazines
with 40,000 rounds to pass the time.
They will never be able to reliably implement this. Literally dozens of private companies and government agencies trying to link all these legacy and proprietary systems will make the website launch look like a massive success.
Who writes all this crap?
Who takes the time?
We know why.
Any bill brought up by congress needs to be made available on the web for the people to read. Didn’t Obummer say he was going to do just that? We should demand that of any candidate.
Would make for some interesting reading.
TostedHead noob poster. You did good.