"Free" Prev Care May Not Be Free

[VolAgent]

It sort of defeats the idea of preventative if when you find something it suddenly becomes diagnostic. Might as well call it what it is in such a case, "Fishing for dollars."

 

[yankee466]

I had a client go in for his "free" colonoscopy. They found a polyp, but he still got the colonoscopy at no charge. However, he got a $500 "facility charge" plus an anesthesiologt charge...plus the charge for the biopsy......but the statement clearly showed the colonoscopy at no charge.

I think he is likely being taken to collections by the facilityby now.....since you can guess where he told them to stick their bill.

 

[Dave020]

I had a client go in for his "free" colonoscopy. They found a polyp, but he still got the colonoscopy at no charge. However, he got a $500 "facility charge" plus an anesthesiologt charge...plus the charge for the biopsy......but the statement clearly showed the colonoscopy at no charge.

I think he is likely being taken to collections by the facilityby now.....since you can guess where he told them to stick their bill.

Have him send it to Obama

 

[cwlives]

Yikes, I just had my age 55 Colonoscopy. Thankfully, we've already met our max OOP for the year so it doesn't much matter how they code it.

Still I gotta line up with VolAgent and ksigmtsu (Middle TN State Univ?) that changing the definition of the procedure midway through isn't gonna fly "long term".

There will be a court case and the insurance company will lose. If you get in front of a jury, the insurance company won't stand a chance. Assurant Health lost a big recission case here in Boulder CO, the jury was licking their chops to find them guilty.

 

[VolAgent]

Yikes, I just had my age 55 Colonoscopy. Thankfully, we've already met our max OOP for the year so it doesn't much matter how they code it.

Still I gotta line up with VolAgent and ksigmtsu (Middle TN State Univ?) that changing the definition of the procedure midway through isn't gonna fly "long term".

There will be a court case and the insurance company will lose. If you get in front of a jury, the insurance company won't stand a chance. Assurant Health lost a big recission case here in Boulder CO, the jury was licking their chops to find them guilty.

Actually, I would say the guilty party is probably the medical provider. I'm not a health agent, so the only EOBs I look at are my own. But I bet diagnostic procedures pay better than preventative, and thus the recoding of procedures.

Heck, with my own EOBs, I can't tell you how many times they try to break an exam into multiple procedures and bill for each one. Most get disallowed by the insurance company. But I'm sure the doctor's office would try to get me to pay for every procedure as billed if I paid in cash.

 

[Crabcake Johnny]

This is a carrier issue? They only handle the claim according to how the providers coded it. If the doctor codes it as preventative then it's free. If the doctor codes it as a test/procedure/etc...the carrier has no clue - goes to the deductible.

I'm not sure the carrier has any liability or responsibility in the matter. This is between the provider and patient.

 

[Yagents]

This AP story hit front page of Yahoo. Some of the comments makes me want to believe that some people are starting to "get it"
Preventive care: It's free, except when it's not - Yahoo! Finance

 

[InsureMonkeyQA]

Thanks guys, seriously good articles. I usually say that newly purchased health plans come with preventive care services 'at no charge' instead of free, because they'd find a way to charge for them. This is a good read for clients who want to know more background on what's happening. The comments on Yahoo are always refreshing to read too

 

[Yagents]

This lady nailed it:

On the Third Hand: Bad Consumer | LifeHealthPro

 

[Ann H]

Good article. This is so infuriating. I just had a client call, who had a well-check at the Dr.'s office, but the doctor sent the lab work TO A HOSPITAL!! The client was billed for $436.