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.

Leave a comment

Cancel reply