Under the federal health reform law, insurers must pay for the full cost of preventive services, leaving patients with no out-of-pocket costs. But according to Harris Meyer of Kaiser Health News, it’s not always that simple. If a preventive test uncovers a problem that gets dealt with during the same visit–say, a colonoscopy that leads a doctor to find and remove a polyp–the patient can be charged hundreds of dollars. The reason? When that happens, the test becomes part of treatment, not preventive.

Critics say the charges defeat the purpose of the law and point to the need for more clarity about to handle such cases.

Not all insurers charge in such cases, but Medicare and commercial insurers Kaiser Permanente and Health Net charge patients when a doctor removes a polyp, Meyer reports. Connecticut’s largest health insurers, Aetna, CIGNA, United Healthcare and Anthem, do not, according to Meyer.

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

Leave a comment