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What the ACA Means for Planning Major Medical Issues

This guest post is from Martin Carpenter, a paralegal focusing in the medical field.

Nearly 60 million Americans undergo outpatient surgery annually, according to a study by Dr. John Hollingsworth of the University of Michigan. Another 51 million receive inpatient surgery, according to the CDC. These numbers include the 600,000 Americans a year who undergo back surgery, as reported by the Today Show. Americans preparing for such major medical procedures might be wondering if the Affordable Care Act’s changes to the health care system affect their plans. While it may affect some aspects of patients’ plans, the general best practices for medical planning remain constant.

Know Your Coverage

The Affordable Care Act requires all major medical plans to encompass 10 minimum health care benefits, including ambulatory patient services, hospitalization, emergency services and rehabilitative care, according to Beyond these basics, specific plans may or may not include additional coverage. Plans follow a tiered system from Bronze to Platinum, with out-of-pocket coverage ranging from 60 to 90 percent.

Also, employer-sponsored plans signed before the law went into effect on March 23, 2010 are grandfathered in and not subject to the ACA, according to Cigna. Before undergoing any medical procedure, review your policy so you know the limits of your inpatient insurance, post-hospital medical insurance and rehabilitation coverage.

Pre-surgical Preparation

General medical planning best practices remain unaltered by the ACA. The Beth Israel Deaconess Medical Center, a Harvard Medical School Teaching Hospital, recommends a series of steps when preparing for joint replacement and reconstruction. These also serve as useful guidelines when planning for other procedures, such as the cutting-edge spinal outpatient procedures the Laser Spine Institute offers patients.

Another best practice is planning your surgery in coordination with your other health care needs. For instance, if you’re going in for certain types of surgery, you may need to schedule a dental checkup well in advance. Some dental procedures can cause bleeding gums, infecting the bloodstream and risking post-surgical infection. Likewise, if you have special medical conditions, such as heart or lung disease, you should consult your specialist to make sure your planned surgery is safe for you.

Do any pre-surgery physical activity your provider recommends. This can include general fitness improvement steps, such as losing weight, as well as pre-operative exercises.

Preparing for Your Return

Preparing for your return home is another important part of medical planning, the Virginia Mason Medical Center emphasizes. First, find out if you will need someone to drive you home. Then make sure your home is ready to accommodate any special needs you will have in areas such as navigating stairs, going to the bathroom and planning meals. Keep a list of emergency numbers within easy reach.

Preparing to return to work is also vital. Talk with your employer about whether or not you will need any reasonable accommodations to continue working as required by the Americans with Disabilities Act.

Bob Kraft

I am a Dallas, Texas lawyer who has had the privilege of helping thousands of clients since 1971 in the areas of Personal Injury law and Social Security Disability.

About This Blog

The title of this blog reflects my attitude toward those government agencies and insurance companies that routinely mistreat injured or disabled people. As a Dallas, Texas lawyer, I've spent more than 45 years trying to help those poor folk, and I have been frustrated daily by the actions of the people on the other side of their claims. (Sorry if I offended you...)

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