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  #1  
Old 03-17-2011, 01:38 PM
sunset sunset is offline
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Default Health Care Reform--Preventative Procedures covered 100%???

I received this email today clarifying how our insurance is going to treat "preventative procedures" with the new health care reform.

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Health Care Reform enacted the policy that medical preventive care visits will be covered at 100%. Examples of preventive services include, but are not limited to, immunizations, an annual well woman exam and various cancer screenings including mammograms and colonoscopy's.

Due to a number of various issues arising from colonoscopy procedures, we would like to make our clients aware of some stipulations regarding these preventive care procedures.

When a procedure such as a colonoscopy is performed strictly as a preventive measure, and done so within the guidelines as set forth by the US Preventive guidelines (i.e. recommended age for procedure), the insurance company should cover the procedure, the facility and the doctors fees at 100%.

However, if any issues are discovered during the procedure, such as a polyp, and it is removed and sent for biopsy, then the procedure is essentially no longer considered preventive, but diagnostic, which is not covered at 100%. Most often, these charges are applied towards your deductible. As such, you could be responsible for a majority, if not all of the associated charges until the deductible is met.
Now I am not a fan of this health care reform. But, this just makes me think that it doesn't matter what congress does, insurance companies will find a way around it.
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Old 03-17-2011, 01:43 PM
amysusi amysusi is offline
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Originally Posted by sunset View Post
Now I am not a fan of this health care reform. But, this just makes me think that it doesn't matter what congress does, insurance companies will find a way around it.
Seems like it. Alot of good heathcare reform will do us now, right. A lot of people will still be in the same boat: avoiding the doc because they can't afford what might be found.
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Old 03-17-2011, 02:18 PM
AnnieGetYourGlueGun AnnieGetYourGlueGun is offline
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Originally Posted by sunset View Post
Now I am not a fan of this health care reform. But, this just makes me think that it doesn't matter what congress does, insurance companies will find a way around it.
Yup.

Here's another example: My Insurance wrote me that well-child visits are covered 100% but not if a procedure is done (like administering an immunization).

Moreover, my premiums AND co-pays went up this year. So essentially I'm paying for the preventive care anyway. And it just makes for more red tape.

It's what I call Obama-care. I'm not impressed.
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Old 03-17-2011, 02:19 PM
crazyfun crazyfun is offline
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Originally Posted by amysusi View Post
A lot of people will still be in the same boat: avoiding the doc because they can't afford what might be found.
??? How does that make sense? I'll avoid the colonoscopy because they might find pre-cancerous polyps... because stage 4 colon cancer is SO cheap and SO fun!
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Old 03-17-2011, 02:24 PM
jonafifi jonafifi is offline
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Originally Posted by AnnieGetYourGlueGun View Post
Yup.

Here's another example: My Insurance wrote me that well-child visits are covered 100% but not if a procedure is done (like administering an immunization).

Moreover, my premiums AND co-pays went up this year. So essentially I'm paying for the preventive care anyway. And it just makes for more red tape.

It's what I call Obama-care. I'm not impressed.

Seriously. My premiums went up over 25%.
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Old 03-17-2011, 02:41 PM
sunset sunset is offline
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Originally Posted by AnnieGetYourGlueGun View Post
Here's another example: My Insurance wrote me that well-child visits are covered 100% but not if a procedure is done (like administering an immunization).
That is terrible. So apparently you need to make separate appointments if you want them both covered 100%--well, if you like to spread out immunizations, then this will reinforce that practice. (Which I do.)
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Old 03-17-2011, 02:45 PM
sunset sunset is offline
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??? How does that make sense? I'll avoid the colonoscopy because they might find pre-cancerous polyps... because stage 4 colon cancer is SO cheap and SO fun!
It certainly seems like this is opposite of what was intended. Yet, it is quite possible people will postpone procedures because the cost could range from zero to hundreds of dollars (I don't know what colonoscopies cost).
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Old 03-17-2011, 02:56 PM
jglass jglass is offline
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I was pretty sure insurance company's were required to also cover the cost of immunizations? For babies pretty much all of the well child checks also include immunizations. As for the premiums, they suck and are expensive. Ours went up $10 a month but it was crazy expensive before Obama went into office and any health care reform was passed so I don't blame reform for that. It was over $600 a month 4 years ago when Bush was in office. As far as I'm concerened healthcare reform didn't go far enough. But I'm all for a public option and think that we lowly citizens should have access to the same healthcare plan that we're paying for our great ellected senators to have.
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Old 03-17-2011, 03:01 PM
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MochaWolf MochaWolf is offline
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Originally Posted by AnnieGetYourGlueGun View Post
It's what I call Obama-care. I'm not impressed.
Of course its not "Obama-care" because it hasn't been inacted yet and doesn't go into affect until 2013. The only thing that has gone into affect is the changes it the FSA and the fact that kids up to age 26 can be covered under Parental insurance policies.

It is the result of the insurance companies trying to make a play for money BEFORE so called "obama-care" goes into affect. Its "insurance-care" or lack there of, but the blame is not being placed where it should go.
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Old 03-17-2011, 03:15 PM
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momtonathanandtwins momtonathanandtwins is offline
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Of course its not "Obama-care" because it hasn't been inacted yet and doesn't go into affect until 2013. The only thing that has gone into affect is the changes it the FSA and the fact that kids up to age 26 can be covered under Parental insurance policies.

It is the result of the insurance companies trying to make a play for money BEFORE so called "obama-care" goes into affect. Its "insurance-care" or lack there of, but the blame is not being placed where it should go.
I fully agree. Where was the outrage when our insurance pulled the we covered the nicu in one hospital but not the doctors or you can go to the other hospital where we cover the doctors but not the nicu? And my mother's health insurance has pulled the same thing on the colonoscopy since 2005, long before "obama care" came about. Even my health insurance last year the procedure was covered 100% unless they remove polyps which caused it to change from a routine procedure to a surgical procedure. Anyone that thinks the insurance companies really care is wrong. The bottom line is they are out to make money for themselves and they have the money to pay lawyers to find all the little loopholes that help keep them from losing their money. Hence the reason so many routinely deny claims and make you play their game long before they have desire to pay your claims.
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