Getting Insurance To Pay For Preventive Health Under The ACA

The Affordable Care Act (ACA) mandates that health insurance companies pay for preventive health visits. However, that term is somewhat deceptive, as consumers may feel they can visit the doctor for just a general checkup, talk about anything, and the visit will be paid 100% with no copay. In fact, some, and perhaps most, health insurance companies only cover the A and B recommendations of the U.S. Preventive Services Task Force. These recommendations cover such topics as providing counseling on smoking cessation, alcohol abuse, obesity, and tests for blood pressure, cholesterol, and diabetes (for at risk patients), and some cancer screening physical exams. BUT if a patient mentions casually that he or she is feeling generally fatigued, the doctor could write down a diagnosis related to that fatigue and effectively transform the “wellness visit” into a “sick visit.” The same is true if the patient mentions occasional sleeplessness, upset stomach, stress, headaches, or any other medical condition. In order to get the “free preventive health” visit paid for 100%, the visit needs to be confined to a very narrow group of topics that most people will find vert constrained.

Similarly, the ACA calls for insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once again there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code other than “routine preventive health screening,” the insurance company may not, and probably will not, pay for the colonoscopy directly. Instead, the costs would be applied to the annual deductible, which means most patients would get stuck paying for the cost of the screening.

This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone – those at risk as well as those facing no known risk – to get checked. But if people go into the procedure expecting insurance to pay the cost, and then a week later receive a surprise letter indicating they are responsible for the $2,000 – $2,500 cost, it will give people a strong financial disincentive to getting tested.

As an attorney, I wonder how the law could get twisted around to this extent. The purpose of a colonoscopy is determined at the moment an appointment is made, not ex post facto during or after the colonoscopy. If the patient has no symptoms and is simply getting a colonoscopy to screen for colon cancer because the patient has reached age 45 or 50 or 55, then that purpose or intent cannot be negated by subsequent findings of any condition. What if the doctor finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? If so, it gives patients a strong incentive to tell their GI doctors that they are only to note on the claim form “yes or no” in response to colon cancer and nothing else. Normally, we would want to encourage doctors to share all information with patients, and the patients would want that as well. But securing payment for preventive services requires the doctor code up the entire procedure as routine preventive screening.

The question is how do consumers inform the government of the need for a special coding or otherwise provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I could write my local congressman, but he is a newly elected conservative Republican who opposes health care and everything else proposed by Obama. If I wrote him on the need for clarification of preventive health visits, he would interpret that as a letter advising him to vote against health care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They have stand pat reply letters on health care reform that they send to all constituents who write in regarding health care matters.

To my knowledge, there is no way to make effective suggestions to the Obama administration. Perhaps the only solution is to publicize the problem in articles and raise these issues in discussion forums

There is a clear and absolute need for government to get involved in the health care sector. You seem to forget how upset people were with the non-government, pure private sector-based health care system that left 49 million Americans uninsured. When those facts are mentioned to people abroad, they think of America as having a Third World type health care system. Few Japanese, Canadians, or Europeans would trade their existing health care coverage for what they perceive as the gross inequities in the US Health Care System.

The Affordable Care Act, I agree, completely fails to address the fundamental cost driver of health care. For example, it perpetuates and even exacerbates the tendency of consumers to purchase health services without any regard to price. Efficiency in private markets requires cost-conscious consumers; we don’t have that in health care.

I am glad the ACA was passed. It is a step in the right direction. As noted, there are problems with the ACA including the “preventive health visits” to the doctor, which are supposed to be covered 100% by insurance but may not be if any diagnostic code is entered on the claim form.

Congress is so polarized on health care that the only way to get changes is with a groundswell of popular support. I don’t think a letter writing campaign is the correct way to reform payment for the “preventive health visits.” If enough consumers advise their doctors that this particular visit is to be treated solely as a preventive health visit, and they will not pay for any service in the event the doctor’s office miscodes the visit with anything else, then the medical establishment will take notice and use its lobbying arm to make Congress aware of the problem.

COMMENT: Should there not be an agreement up front between both parties on what actions that will be taken if said item is found or said event should be seen or occur? Should their be a box on the pre-surgical form giving the patient the right to denying the doctor to take proper action (deemed by whom?) if they see a need to? Checking this box would save the patient the cost of the procedure, and give them time for a consult. If there is not a box to check, why isn’t there one?

There are two separate questions posed by the checkbox election for procedures. First, does a patient have a legal right to check such a box or instruct a physician/surgeon orally or in writing that he does not give consent for that procedure to be performed? The answer to that question is yes.

The second question is does it serve the economic interest of the patient to check that box? For the colonoscopy, in theory the patient would get his or her free preventive screening, but then be told the patient needs to schedule a second colonoscopy for removal of a suspicious polyp. In that case, the patient would eventually have to pay for a colonoscopy out of pocket (unless he had already met his yearly deductible), so there is no clear economic rationale for denying the physician the right to remove the polyp during the screening colonoscopy.

But we are using the much less common colonoscopy example. Instead, let’s return to preventive care with a primary care doctor. Should a patient have the right to check a box and say “I want this visit to cover routine preventive care and nothing more”? Certainly. There is way too much discretion afforded physicians to code up whatever they want on claim forms such that two physicians seeing the exact same patient might code up different procedures and diagnostics for the exact same preventive health screening visit.

When I expect to receive a “zero cost to me” preventive screening, I do not imply that I am willing to accept a “bait and switch” change of procedure and payment due to the doctor from me. The “zero cost to me” induces consumers to go to the office visit; it is actually paid for out of the profits earned by the health insurance firms to whom consumers pay monthly premiums. Consumers need to hold doctors financially accountable for their claim billing practices. If you are quoted a “zero price” for a visit, the doctor’s office better honor that price, or it amounts to fraud.

It is all too easy to find any little old thing to justify billing a patient for a sick visit instead of a wellness visit. However, it is up to the patient to prevent that kind of profiteering at his or her expense.

It would be wonderful if HHS would give carriers the proper code or specify that other diagnostic codes cannot negate the preventive screening code used for a wellness visit. That is not happening now. DHS has been bombarded with so many questions and suggestions for health care reform that the department has a fortress like mentality. So realistically, consumers cannot expect DHS to address the coding issue for preventive health screenings any time soon. That leaves the full burden to fall on each consumer to ensure the doctor’s billing practices match the patient’s expectations for a free preventive health office visit.

I investigated the web site http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html and discovered some inconsistencies. For example, the site purports to list the services covered under the “preventive health” coverage benefit, yet it omits the annual physical exam. Also, the site states that colorectal cancer screening are provided for people age 50 or older. However, I have been advised in writing that United Healthcare will cover preventive screening colonoscopies for people under age 50. In essence, that government web page is a good start to learn about preventive health care benefits, but a better source would be each consumer’s own health insurance carrier. For those with temporary insurance or who are without any insurance coverage, unfortunately, the preventive health benefit of the ACA will not have any practical consequence.

Where will the money come from for the preventive health screening visit to a primary care doctor as well as the screening colonoscopy? We have to look at different scenarios. If the patient indeed has preventive health screenings with no other medical diagnoses, then the patient will be charged $0 for these services, and they will be paid for by the insurance carrier. The insurance carrier will pay these costs out of its operating income or profits. There is simply no other source for payment. The government has not offered to pay the insurance companies for these services.

If the patient is hit with various medical diagnostic codes during these preventive health screenings, then he or she will pay his customary charge for the primary care doctor’s office visit and the contract-negotiated price for the diagnostic colonoscopy. In that scenario, the consumer will be paying most of these costs, although the visit to the primary doc may be limited up to any applicable copay amount.

It is not a big shock or surprise to say preventive health care is going to be borne by health insurance carriers. The extent to which these carriers can pass along costs to consumers through higher rates depends on the degree of competition in their markets. Ehealthinsurance.com advises me that for the vast majority of states, the insurance carriers have NOT been able to shift these costs onto consumers through higher rates. That may change in 2013 or 2014. However, the trend is clearly moving in the direction of more power for consumers, more options and carriers available to supply health insurance in their states, which means greater competition and lower prices.

 

5 Personal Information Answers You Must Know Before Getting Insurance Quote

Many people think that getting an insurance quote is so easy that it only takes one phone call, five minutes of time and the quote is ready. In reality, it takes more than five minutes and lots of questions given to you by the insurance agent. A good agent will question you to find out you unique situation and will create a custom quote just for you. So be ready to answer personal information questions before you call for a quote.

Here are five questions that insurance agent asks before it gives you a quote.

1. Name of the person who owns the property and will be listed on the policy as named insured. It is very important to give the agent the legal name of the insured, as it appears on your identification card, so if a claim occurs, the check will be written to the right person. If name changes appear in the future, after the policy is already issued, the name change needs to be reflected and updated on the policy. If you have a mortgagee or loan holder, it should be listed as additional insured. If lien holder changes, insurance company needs to be notified about the change.

2. Date of birth of the insured to be listed on the policy. Many insurance companies give a discount to individuals over 50 years old. If you have very common name, date of birth will identify you among other individuals with the same name. You would not want to have the responsibility of the other person’s claims, would you?

3. Social Security Number is important determining the policy premium. Insurance companies like high credit scores, as it shows you being on time paying your bills. Before you call for a quote, look up your or your spouse’s credit score. Ask the agent to put the name of the person with highest score first on the policy.

4. Employment status guaranties the insured has enough of income to pay for the insurance policy. Some insurance companies like employed individuals holding high positions in the company, or specific occupations more favorable. Again, it shows the insurance company that the insured will be capable of paying the bills on time.

5. Education is important factor with some insurance companies. Education mostly influences auto insurance premiums. Insurance companies think that more educated individuals are less inclined to have a claim and are more responsible, so the company will face fewer losses.

Temporary Car Insurance – A Convenient Way to Get Insured

In the past this has been quite awkward to organise quickly and it used to mean that anyone driving your car would have to be put on your existing insurance policy. Today however, it is possible to arrange temporary car insurance cover through many insurance companies quickly and effectively with the click of a few buttons.

This convenient and fully comprehensive cover can be obtained by going on the Internet and browsing through the websites of the many companies who now offer it to drivers, even those who are under twenty five years old. You can organize online, pay for it and have it in place in a matter of minutes. The policy is active as soon as the payment is made to the company.

There are various options which can be added to the short term insurance cover and these are very well listed and explained on all the websites. You can choose between a single days’ cover or up to twenty eight days cover, whichever is the period of time you need the cover to be in place.

Another bonus to taking out short term insurance cover is that it is totally separate from your own policy on the vehicle. It is arranged independently of all existing insurance policies which means should anything untoward happen whilst the car is being driven by the driver of your choice and your ‘no claims bonus’ which you have on your main policy will not be affected.

Temporary car insurance cover can be taken out for whatever reason you need to have in place. It is quick to organize, convenient when money is tight and you cannot afford the annual car insurance premium as well as being a great way to arrange to either drive someone else’s car or for them to drive yours should the occasion ever arise.

Drivers under the age of twenty five can also apply for this type of short term cover but must be prepared to pay slightly higher premiums as is normally the case with annual insurance premiums they take out with most car insurance companies.

The single or one day option of short term cover means that you can get insurance even when you are test driving a car you are thinking about buying and if you do purchase the vehicle you are covered to get it back to where you live.

In some instances it may even work out less expensive to arrange temporary car insurance cover than to actually pay for the full year so when money is short, it is a very viable option which means you can still use your car legally on the road and there is a chance you might save money over the period of twelve months.

How To Get Insurance Quotes

It is very possible to get many insurance quotes before making the final decision to what insurance policy you are going to go with for your particular insurance needs per se. How to get quotes to you, well the answer will be one that only you can determine best by the kind of search that you do from online. How thorough you are with your research will only yield the most possible of all good results hopefully in the end. Insurance quotes to you are what you make them to be in connection with the kind of prospects you wish to come away with.

Before you can conduct your search for quotes, you must first know what type of insurance it is you are seeking to get quotes on as a rule. This is the thing to know at the top of the list. As there are different things to know about car insurance per se and the same applies to life insurance or any other type of insurance.

What is great about shopping for any insurance requirements online, no matter what the policy is to be, is the ease of use and convenience that is in connection with such a search. There is also no time constraint with an online insurance quote search. Therefore, this is another advantage of how to get insurance quotes to you very simple.

In today’s world, time is something that a lot of people don’t have much of, between trying to hold down a career, having a family, and juggling all of the daily activities of a life in between. Therefore, their time is limited sometimes due to this and that. Something, which is a true reality in a fast-pace environment that can be one’s life and requires a schedule in some cases to get things done that are many in number.

Insurance needs do change as one’s life does change. So it is very important to know exactly what type of insurance you need a specific quote on for that special time in your life per se. Auto insurance, life insurance, home insurance, renters insurance, et al. This is imperative before you go out online looking.

Therefore, once you have the specific product information that you need in hand. Then you proceed to start your online search for a few different insurance quotes at a time concerning the type of insurance that you must have. After compiling a nice amount of quotes for the classification of insurance that you want, the next step is to take the quotes and compare them one by one. Now that you have quotes to you and for you, the comparison of all the quotes that you gather will finally help you determine which insurance carrier will be the one for you.

How you can get insurance quotes to you is much easier by doing it online. Because the questionnaire can be in filling out by you at your leisure and pace, as there is no deadline or specific time to complete it.