Today, I was mailed a flyer from Anthem Blue Cross that gave a list of the things that this insurer considered to be “preventative care”. Americans can go to HealthCare.gov to read what the federal government has, by law, included under “preventative care”. I wondered how well these two lists matched each other.
I have already canceled my health insurance policy with Anthem Blue Cross. So, this blog is basically an exercise designed to satisfy my curiosity about how well, or how poorly, this insurer is following the laws regarding the types of health treatments and tests that are officially considered to be “preventative care”.
First, let me explain a little background information that you may not know. Insurance companies are required by law to provide everything that falls under the category of “preventative care” to policyholders without charging them a co-pay, deductible, or co-insurance.
The majority of the health care laws that focus on preventative care were passed in September of 2010. If you bought your health insurance before September 23, 2010, then your insurer doesn’t have to follow this law. If you are getting health care from a provider who is not a “network provider”, then your insurance company can charge you fees, even though you received something that was included as “preventative care”.
To make this comparison, I used the following resources. I read over the flyer that Anthem Blue Cross mailed to me that lists the things that they consider to be “preventative care”. I compared that with the information that describes what is supposed to be covered as “preventative care” that is on the HealthCare.gov website.
Many things were the same, but there were some notable difference between these two lists. First of all, the list from Anthem has a disclaimer that says that if this list is in any way different from a person’s health insurance policy, that the insurer will ignore the list and go by what is in the policy. It says that people should review their policy limitations. It also has this curious disclaimer:
“Preventative Health Guidelines reflected in this document are recommendations for individuals of average risk. Individuals who are higher-risk, including but not limited to those in certain racial/ethnic groups, or with personal/family medical history, should check with his/her health care provider for preventative health guidance”.
The official list of preventative services that are covered by the Affordable Care Act, that are on the HealthCare.gov website, doesn’t come with a disclaimer like the one that Anthem has chosen to add onto its list of preventative care. The official, federal, list says things like “all adults”, or “all adults of certain ages or higher-risk”, or “for sexually active females” or “for adolescents”, or “for children”.
HealthCare.gov says: “Colorectal Cancer screening for adults over 50” is covered. Anthem says: “Colorectal cancer screening including fecal blood test, barium enema, flexible sigmoidoscopy, screening colonoscopy, and CT colonography (as appropriate)” is covered. Who decides if that care is “appropriate”?
HealthCare.gov says: “Aspirin use for men and women of certain ages” is covered. Nothing is said about aspirin being covered as part of preventative care on the list from Anthem. You just might get charged for one of those super expensive aspirins that are dispensed in hospitals if you have Anthem Blue Cross health insurance.
Image by Christian Prade on Flickr