"Free" Prev Care May Not Be Free

[jaystar]

UHC says preventive colonoscopy "no charge".....but...if they find something then it becomes diagnostic and there is a charge.

 

[yaknow1]

Good article. This is so infuriating. I just had a client call, who had a well-check at the Dr.'s office, but the doctor sent the lab work TO A HOSPITAL!! The client was billed for $436.

That is a normal practice. Sounds like when the paperwork went from the doctor's office to the facility the preventative dx codes weren't on the order, or weren't put in. It was probably submitted as diagnostic and hit the deductible.

 

[Yagents]

Just got off the phone with a client and ins co for an hour. The client brought her actual policy into the doctors office which spelled out the allowed free preventative care tests. The doctor interpreted it wrong, ordered certain "PC" tests to be done (Vitamin D test / B12 testing / Folic testing), client just got stung by the bill in the mail for those items not covered. Cost = $367. The client did everything possible to follow the guidelines, and still got stung.

 

[taterpeeler]

Just got off the phone with a client and ins co for an hour. The client brought her actual policy into the doctors office which spelled out the allowed free preventative care tests. The doctor interpreted it wrong, ordered certain "PC" tests to be done (Vitamin D test / B12 testing / Folic testing), client just got stung by the bill in the mail for those items not covered. Cost = $367. The client did everything possible to follow the guidelines, and still got stung.

A lawsuit is all that is going to get the doctors attention that they need to learn the preventive Benny in dumbprez care.... They were headstrong in support this doctor bailout provision. It's their flat and they can f off

 

[Yagents]

How many of your clients have been screwed?

Report: Consumers May Be Getting Charged For Free Colorectal Cancer Screenings | wusa9.com
GREENBELT, Md. (WUSA) -- Not all consumers are receiving free colorectal cancer screenings as required by the Affordable Care Act (ACA), Kaiser Family Foundation reported.
According to the report, consumers may face cost sharing depending on the provider, insurance that administers plan and the state the person lives in. The study came about after several consumer complaints of unexpected colonoscopy bills, the foundation stated.
The report, Title, states that these unwarranted charges occur when the health care provider codes the procedure as a diagnostic instead of a preventative. The Kaiser Family Foundation says "additional clarification from the federal government could reduce coverage inconsistencies."

 

[VolAgent]

Let me guess, diagnostic colonoscopies pay more than preventative colonoscopies?

 

[somarco]

Here is the actual report.

http://www.kff.org/healthreform/upload/8351.pdf

Diagnostic procedures usually involve a biopsy (surgical procedure).

 

[Cory]

I've had many clients get billed for services that were truly preventive and covered and it comes down to the coding. Unfortunately, you'd think this would be a simple process but my clients have had to follow up, follow through and follow everyone from the receptionist to the insurance company through the entire process . I've not seen many insurance companies handle the preventive care process from beginning to end where customers haven't gotten frustrated. Anybody have some tips on ensuring seamless preventive care services are covered?

 

[somarco]

It helps if the agent and patient read their policy before the procedure and print out a list of the covered "free" items. Most docs that handle Medicare patients are aware of what is "free", what isn't.

Prevention & Wellness | HealthCare.gov

Both patient and agent should also know the difference in a preventive screening and a diagnostic test. One may be "free" while the other is not.

 

[Yagents]

Scope out your doctor, before you get scoped

How To Avoid A Colonoscopy Billing Kerfuffle : Shots - Health News : NPR