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Advice for consumers being charged for preventive care

Under the new health law, compliant plans are to cover certain preventive care procedures. For example, many immunizations, cancer screenings, depression screenings, and so forth are supposed to be free to covered consumers. For a list of covered preventive care services and associated requirements, click here.

However, some consumers are being charged fees for these services, often due to billing errors. In the past, some services– take, for instance, colonoscopies– would be charged for the procedure itself, plus a facility fee for use of space and equipment at a medical center. Now, charges for these covered preventive services should be “bundled” under a single billing code which signals to insurers that the entire service should be covered with no cost-sharing on the part of the patient.

Since the law is new, and billing processes are often quite old, some patients are (perhaps mistakenly) being asked to pay for part of the cost of preventive procedures. If this happens to you, it would be wise to:

1) Ensure that your health plan is compliant with the new health law’s essential health benefits– if you purchased the plan on a Marketplace, it’s compliant;

2) Review the list of fully covered preventive services; and

3) Call your provider and/or insurer to ask about how the procedure was billed. Were the charges for the procedure and the facility billed under separate codes? Or, were they bundled? If they were billed separately, why? Since some processes for coding these preventive procedures are new, perhaps the provider’s billing agent made a mistake which can be easily corrected.

Click here to read a Kaiser Health News article on this topic, published on Jan. 21, 2014.

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This post was contributed by Shannon Saksewski (Health Education Program Manager, Detroit Regional Chamber).  Shannon can be contacted at