According to multiple reports and her own written statements, Emilie Lamb was one of the very few who were actually harmed by the Affordable Care Act. However, her pre-existing condition placed her as eligible for a different program than the one she claimed to be on--one that has costs that are practically identical to her current Platinum Plan under Obamacare.
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CoverTN -- her claimed insurance policy has a much lower deductible but comes with a kicker - a $25,000 per year annual cap.
AccessTN -- is for people with pre-existing conditions, it has much higher premiums but doesn't have an annual cap.
• Medically uninsurable as demonstrated by one of the following: *
» A doctor's statement that applicant has one of more than 55 medical conditions pre-approved for presumptive eligibility
(follow the link): 47 Other Systemic Lupus Erythematosus (Lupus Erythematosus)
Both of these plans are offered under the overarching program called "CoverTN" which was the name of the original legislation.
Was she actually covered under the AccessTN program and not CoverTN?
Well, I submit the following:
http://www.politifact.com/...
1. Emilie Lamb is 40 years old
2. (from the video) She contracted Lupus when she was 27, (13 years ago)
3. The CoverTN program began taking applications in 2007 (7 years ago)
4. She had Lupus as a pre-existing condition at the time of her application
5. Lupus is listed as a specific condition that qualifies someone for AccessTN
see: http://www.covertn.gov/...
6. Lupus is not a listed condition that is covered by CoverTN
see: https://www.bcbst.com/...
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However:
pre-existing conditions are allowed if someone waits 12 months in the CoverTN program
http://www.bcbst.com/...
Does CoverTN have a pre-existing condition waiting period?
Yes. CoverTN has a 12-month pre-existing condition waiting period. No benefits will be paid for conditions that were pre-existing during the six months prior to enrolling in CoverTN. After the member has been enrolled for 12 months, the plan will begin covering these conditions. The pre-existing condition waiting period can be shortened or waived for members with prior creditable coverage who apply within 63 days of an involuntary loss of their coverage.
--so it is potentially feasible that she paid for 12 months of CoverTN care before she received treatment for Lupus and received a special circumstance that allowed CoverTN to be billed and pay out for her LUPUS care.
--in addition, since CoverTN doesn't pay for the care that was issued for the 6 months prior to her application, she was likely paying those 6 months of care out of pocket as well.
however,
in that case, the typical annual expensefor the treatment of Lupus is $12,000 to $17,000
per year, or $18,000 to $25,000 for an 18-month period
Which, if averaged out over the period of her coverage means that she pre-paid an extra $3,000 per year (over the 7 years of her coverage) to be on CoverTN as opposed to the program that was specifically designed for her (AccessTN).
Note: if she had out of pocket costs in the 6 months prior to her application (likely) then AccessTN would cover the majority of those costs as well.
8. I do not find it credible that a person would spend an additional $12,000 to $17,000 for an entire year of Lupus care just so that they could enroll in a cheaper plan that has a $25,000 annual cap which (if she has complications to Lupus or other problems) she would have to cover the remainder out of pocket.
In any event, the entirety of the story is not being told.
Either she was on AccessTN and is bending the truth or she paid for her Lupus care for the 12 month period that she was covered by CoverTN before CoverTN opted to begin offering payment for the treatment of her Lupus.
It is likely that the year of medical costs incurred while under the wait period was between $12,00 and $17,000.
This makes the entirety of her story half-told (at best) and a complete fabrication (at worst).
update
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This topic was explored in further detail here: http://www.dailykos.com/...
This diary, however doesn't address the fact that CoverTN has a 12-month wait period for pre-existing conditions, so it is a good adjunct to this one (and vice/versa)