Epilepsy Foundation

What is essential to your epilepsy care?  What coverage do you need?  What obstacles have you faced in trying to gain or maintain access to treatments or specialists?  What is an "essential health care benefit" to you? 

For many people essential benefits may mean coverage of their neurologist or epileptologits visits.  Others may be solely focused on affordable access to their SPECIFIC epilepsy medication.  Health care systems (hospitals, clinics, physician offices, pharmacies), health insurance, and payment (copay, premiums, out of pocket payment) is HOW most people access essential health care needs.  What is essential to many is receiving the actual care at a price they can afford.  

The Epilepsy Foundation is interested in what you believe are essential benefits.  We are asking you to send an email to the Secretary of Health and Human Services.  Your response will be shared with HHS and the White House; and it will help us as we advocate for health care reform implementation that provides for the needs of the epilepsy community. 

The Affordable Care Act (ACA) requires that certain insurance plans—including those participating in the state purchasing exchanges—cover a package of diagnostic, preventive, and therapeutic services and products that have been defined as “essential” by HHS.  The essential health benefits (EHB)—constitutes a minimum set of benefits that the plans must cover, but insurers may offer additional benefits. HHS is working to define what EHB means, how it will be evaulated or changed, and what the impact of EHB is on coverage. Add your experiences to this discussion! 

We think this is a valuable opportunity and encourage Epilepsy Foundation advocates to share their personal or anecdotal experience with HHS staff.  You should consider remarks that focus on the following questions: 

  • How is access to insurance important to YOUR treatment of epilepsy?
  • What type of care and treatments are critical for people with epilepsy?
  • What is affordable?
  • How do monthly premiums, copays, and coinsurance costs factor into YOUR adherence to medical treatment  and access to care (staying on a therapy or going to scheduled/suggested physician appointments)?
  • How have different insurance policies (employer small or large; private individual market insurance; or government employer insurance) provided/restricted access to care?
  • How have insurance policies responded to YOUR request for coverage of epilepsy treatment and care (have your been denied coverage, do you have to appeal for coverage)?

Click here now to share your story!

Background:  The ACA will help ensure that Americans have access to quality, affordable health insurance.  To achieve this goal, the law ensures plans offered in the new Affordable Insurance Exchanges offer a package of essential health benefits.  The statute directs the Secretary of HHS to consider the scope of benefits provided under a typical employer plan in defining essential health benefits.  To inform the Department, HHS received a survey of employer-sponsored coverage conducted by the Department of Labor as well as recommendations from the Institute of Medicine on the criteria and methods for defining and updating essential health benefits.   


For more information you can read the Institute of Medicine (IOM ) report at: http://www.iom.edu/Reports/2011/Essential-Health-Benefits-Balancing...

Views: 317


You need to be a member of Epilepsy Foundation to add comments!

Comment by Angela on December 19, 2011 at 3:46pm

You still have time as we will share this feedback with HHS over the next few weeks!  Thanks!

Comment by bryan farley on November 29, 2011 at 6:04pm

thanks Angela. How long do we have to reply?

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