Are you being billed for free preventive care under new healthcare law? « Health Insurance Advisory

Are you being billed for free preventive care under new healthcare law?

Author: Allan Z - Founder Editor | Jan 02 2012 | New Healthcare Law, Preventive Care Services - New Healthcare Law

The new healthcare law requires individual medical health insurance plans and employer sponsored group health insurance plans that were effective after March 23, 2010 to cover preventive care services at 100%. This means you cannot be charged a copayment or be required to satisfy a deductible before the policy pays for preventive care benefits mandated under the Affordable Care Act.

Complaints from patients are now beginning to surface because of the manner in which claims are being coded by healthcare providers. According to a recent article by the Chicago Tribune, a small business owner from Phoenix, Arizona was told by his health insurance company that his colonoscopy would be free, but was later stuck with a $1,100 bill. Evidently, the preventive care screening turned into a diagnostic procedure because his doctor removed two non-cancerous polyps during the procedure.

There is also confusion with breast cancer screening too. In certain instances, healthcare providers are labeling mammograms as diagnostic, rather than preventative.  “Since a diagnosis is present, the health insurance company applies the appropriate cost share (copayment, deductible, coinsurannce, etc),” according to Allan Zee of”  This results in patients having to participate in the cost,” says Zee.

Stop-smoking interventions are also supposed to be free. However, it is not exactly clear what that means. Does it include counseling? Nicotine replacement therapy? What about drugs like Wellbutrin or Chantix that can help individuals kick the habit? Are they free?  Unfortunately, that hasn’t been clearly laid out, says other healthcare professionals.

Doctors and prevention advocates are asking Congress to revise the new healthcare law by waiving patient costs for a screening colonoscopy where polyps are removed. The American Gastroenterological Association and the American Cancer Society are also pushing Congress to fix the problem because of the confusion it’s causing for patients and doctors.

States are starting to notice too. After complaints piled up in Oregon, insurance regulators now are working with doctors and health insurers to make sure patients are not surprised by charges when polyps are removed.

Florida’s consumer services office also reports complaints about colonoscopies and other preventive care. Many insurance agents are also receiving complaints from their client’s about being billed for preventive services. recommends that you ask your health insurer under what circumstances would a claim for preventive care turn into a diagnostic service. You will also want to ensure that your healthcare provider codes your preventive care screening service as “preventive.” If they attach a diagnosis, then your health insurer will consider the service “medically necessary.” This will definitely result in cost sharing being applied.

For other money saving tips and information regarding the new healthcare law, visit Our online health insurance quotes can also help you save money on individual medical health insurance.

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