Under the Affordable Care Act, certain high-value preventive services – such as colonoscopies – are supposed to be free. No co-pay for the patient.
But some patients are getting charged when they don’t expect it and perhaps shouldn’t be.
And there is a lot of inconsistency on who gets charged, depending on individual circumstances, what state they live in and what health plan they have. Part of it is confusion about what constitutes “screening” and what constitutes treatment. Plus doctors vary in how they “code” and bill for these services.
The variance is not just based on the individuals’ health circumstances (i.e. whether they had a polyp or not), but what state they live in, what health plan they have. The whole thing is generating confusion and complaints – and it’s a good story.
The thinking behind making preventive care free – specific preventive services, graded A or B by the U.S. Preventive Services Task Force (USPSTF) – is that it makes it more accessible. It’s easy to put off – and put off and put off – screening. Research has shown that having to pay for it is an additional barrier.
The Kaiser Family Foundation, the American Cancer Society and the National Colorectal Cancer Roundtable just put out a report examining the problem. Three scenarios seem common: Continue reading