It has been five years since the beginning of the Affordable Care Act (ACA), also known as Obamacare. By now, most know that the new law has changed a lot of things about healthcare. An aspect that effects everyone is what insurance companies are required to cover in plans enrolled in after January 2014. These required coverages are known as the 10 Essential Health Benefits (EHB’s). One of these EHB’s is preventive care. Let’s take a look at how ACA has changed this aspect of healthcare.
Prior to ACA, some health insurance plans covered preventive care as any other trip to the doctor or hospital. There were costs to the member for the visit and tests. Since ACA, the law has required all health insurance plans to cover preventive care 100% which means it is free to the member. Like most situations however, there are precautions to take.
The new law has defined certain procedures classified as preventive. It is a short list of tests that many doctor’s offices add to during routine physicals. The part of this law that mostly affects insured members is what each insurance company considers as preventive. Every insurance company can decide what they consider preventive but are required to at least cover the preventive lists the government outlines.
Last year, I had a personal experience with this very situation. Utilizing my preventive care service from my policy with Regence Blue Cross Blue Shield of Utah, I scheduled an appointment with my doctor for a physical. The tests were run and results later given in another visit. Shortly after the tests were ran, I received an Explanation of Benefits from Blue Cross saying I owed money for a portion of the physical.
After researching the reason for the additional fee, I found there were extra tests run which were not included on the preventive care list from Blue Cross. I filed an appeal persuasively asking them to reconsider the tests they consider preventive but it was denied and I paid the amount I was charged.
After further research I found that each insurance company in Utah is somewhat different with the preventive tests they accept as preventive. I found that Select Health is the most liberal covering the most tests doctor’s offices run for a physical.
What can you do to ensure you have a 100% preventive physical? Talk with your doctor’s office when you schedule an appointment. Tell them who your insurance provider is and explain you want to have a physical that does not result in additional costs to you. They should know which tests are covered by your insurance and which ones aren’t. If, of course, you want the tests run that are not considered preventive to the insurance company, the amount will be subject to your deductible and coinsurance as long as your doctor is an in-network provider with your insurance company. It is important to educate yourself on how your plan works and how to utilize it in your best interests. Preventive care benefits are available but be sure to use caution in the complicated, fine-print details of the law.