The Affordable Care Act (ACA) mandates that medical health insurance companies buy preventive health visits. However, that term is somewhat deceptive, as consumers may feel they are able to visit the physician for only a general checkup, discuss anything, and the visit is going to be paid 100% with no copay. In reality, 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 in danger patients), and some cancer screening physical exams. BUT if a patient mentions casually he or she's feeling generally fatigued, the doctor could jot down a diagnosis related compared to that fatigue and effectively transform the "wellness visit" in to a "sick visit." Exactly the same holds true if the in-patient mentions occasional sleeplessness, upset stomach, stress, headaches, or any other medical condition. To be able to have the "free preventive health" visit paid for 100%, the visit needs to be confined to a very narrow band of topics that many people will see vert constrained.
Similarly, the ACA requires insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once more there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code besides "routine preventive health screening," the insurance company might not, and probably will not, purchase the colonoscopy directly. Instead, the costs would be applied to the annual deductible, meaning most patients would get stuck investing in the price of the screening.
This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone - those at an increased risk along with those facing no known risk - to have checked. But when people enter the task expecting insurance to pay for the cost, and then the week later get a surprise letter indicating they're in charge of the $2,000 - $2,500 cost, it can give people a powerful financial disincentive to getting tested.
Being an attorney, I wonder how regulations could easily get twisted around to the extent. The goal of a colonoscopy is set right now an appointment is manufactured, not ex post facto during or following the colonoscopy. If the patient does not have any symptoms and is simply finding a colonoscopy to screen for colon cancer because the in-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 physician finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? In that case, it gives patients a solid incentive to tell their GI doctors that they're only to note on the claim form "yes or no" in response to a cancerous colon and nothing else. Normally, we'd want to encourage doctors to generally share all information with patients, and the patients will want that as well. But securing payment for preventive services requires the doctor code up the whole procedure as routine preventive screening.
The question is just how do consumers inform the us government of the requirement for a particular coding or elsewhere provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I really could write my local congressman, but he's a recently elected conservative Republican who opposes healthcare and anything else proposed by Obama. If I wrote him on the requirement for clarification of preventive health visits, he'd interpret that as a letter advising him to vote against medical care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They've stand pat reply letters on healthcare reform which they send to all constituents who write in regarding health care matters.
To my knowledge, there's no way to create effective suggestions to the Obama administration. Perhaps the only solution is always to publicize the issue in articles and raise these issues in discussion forums
Medicare Supplement plans 2020
There's a clear and absolute requirement for government to get involved in the health care sector. You seem to forget how upset everyone was 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 medical care coverage for what they perceive as the gross inequities in the US Health Care System
Similarly, the ACA requires insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once more there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code besides "routine preventive health screening," the insurance company might not, and probably will not, purchase the colonoscopy directly. Instead, the costs would be applied to the annual deductible, meaning most patients would get stuck investing in the price of the screening.
This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone - those at an increased risk along with those facing no known risk - to have checked. But when people enter the task expecting insurance to pay for the cost, and then the week later get a surprise letter indicating they're in charge of the $2,000 - $2,500 cost, it can give people a powerful financial disincentive to getting tested.
Being an attorney, I wonder how regulations could easily get twisted around to the extent. The goal of a colonoscopy is set right now an appointment is manufactured, not ex post facto during or following the colonoscopy. If the patient does not have any symptoms and is simply finding a colonoscopy to screen for colon cancer because the in-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 physician finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? In that case, it gives patients a solid incentive to tell their GI doctors that they're only to note on the claim form "yes or no" in response to a cancerous colon and nothing else. Normally, we'd want to encourage doctors to generally share all information with patients, and the patients will want that as well. But securing payment for preventive services requires the doctor code up the whole procedure as routine preventive screening.
The question is just how do consumers inform the us government of the requirement for a particular coding or elsewhere provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I really could write my local congressman, but he's a recently elected conservative Republican who opposes healthcare and anything else proposed by Obama. If I wrote him on the requirement for clarification of preventive health visits, he'd interpret that as a letter advising him to vote against medical care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They've stand pat reply letters on healthcare reform which they send to all constituents who write in regarding health care matters.
To my knowledge, there's no way to create effective suggestions to the Obama administration. Perhaps the only solution is always to publicize the issue in articles and raise these issues in discussion forums
Medicare Supplement plans 2020
There's a clear and absolute requirement for government to get involved in the health care sector. You seem to forget how upset everyone was 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 medical care coverage for what they perceive as the gross inequities in the US Health Care System
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