Insurers interpret preventive services differently
Although the Affordable Care Act requires insurance companies to cover certain preventive services--like health screenings, immunizations and contraceptive services--many insurers aren't interpreting the provision in the same way, reported Politico.
For example, when consumers get a free colonoscopy that reveals polyps, do insurers have to pay for their removal? Since ACA regulations don't explain what's covered specifically, insurers have been answering that question differently. There's been "a fair amount of confusion" regarding preventive services as consumers start using plans sold on the health insurance exchanges, Katherine Hempstead, who works on coverage issues at the Robert Wood Johnson Foundation, told Politico.
When it comes to the colonoscopy example, it's also uncertain whether insurers must cover treatment after the polyp is found and removed. If a member doesn't have cancer, insurers need to know whether any subsequent colonoscopies would be considered routine screenings or diagnostic procedures.
"The difference is a person paying $1,300 to $1,700 or nothing, and how [doctors and insurers] handle it is all over the board," Robert Luisana, an insurance broker in North Carolina, told Politico.
Other situations that may arise include whether insurers should cover prescription drugs that help members stop smoking and counseling under the smoking cessation benefit.
"Translating this benefit into medical practice has required, and probably will still require, some more [federal] guidance," said Susan Pisano, spokeswoman for America's Health Insurance Plans.
Some lawmakers are working to institute that guidance. Sen. Sherrod Brown (D-Ohio), for instance, introduced a bill that would make all colorectal cancer screenings, including polyp removals, free for Medicare members, reported the Lancaster Eagle Gazette.
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