r/boston • u/surfgirl13 • 3h ago
Politics 🏛️ Just a public service
So, the Governor passed some laws about no prior authorizations in certain situations. She is campaigning on this. Sounds good, right? Well, hold on. I found out today that it did not apply to my insurance. I’m trying to get a PA on a breast MRI for screening for breast cancer. I have had breast cancer & I have a pathogenic BRCA 2 gene mutation. That just means I am at higher risk. My insurance company is making it incredibly difficult. I saw the Governor’s ad today & I looked it up and it does apply to anything for screening or treatment of cancer. So, I called Cigna. That is when I found out my plan doesn’t count.
You see, if your insurance plan is what is referred to as “self insured” the rules don’t apply to you. Almost every, if not every large employer is “self-insured” that simply means they pay the bills & they hire an insurance company to be the administrator. All union health insurance is self insured. Every hospital, the state itself. I have not dealt with this end of healthcare in a long time but I want to say if you have more than 100 participants on your insurance plan, it is better to be “self insured”. Regardless, accountants tell businesses yes or no on this. The vast majority of privately insured individuals in the country are on “self-insured” plans. The term is confusing. At any rate, the rules about prior authorizations and copays etc do not apply to self insured plans. Full stop. Further, I learned from Cigna that while my employer is in Massachusetts, they are in a lot of states & countries for that matter, but they write the policies out of Florida because there are no state regulations in Florida & the insurance company can do whatever they want. I later learned that most of these national carriers like Cigna, United, Aetna regardless of where the business they are working with is located, base the policy out of Florida for this reason. Just in case you know. Generally a company who has offices in many states is going to use a national company like this so they don’t have to use a bunch of different companies for different states.
But just so you know, if you get your insurance from your employer & your employer “self-insures” then none of those new rules apply to your insurance. The Governor knows this. I did not. This would be most of the people insured through their employer.