In 2010, the federal government passed a law under the Affordable Care Act. This law required all health insurance companies to provide everything that was officially considered as preventative care to their customers for free. The problem is, many health insurers have found “loopholes” to avoid having to give away free preventative care.
According to HealthCare.gov, all health insurance plans that were purchased after September 23, 2010, are required to offer all preventative services for free to their customers. The insurer is not allowed to charge for those forms of health care, and cannot make their customers pay a co-payment, to pay co-insurance, or to pay off their deductible in order to receive the free preventative care.
As of August 1, 2012, health insurers will also have to offer several types of women’s health care for free, because it has also been included as preventative care. This means that if a woman purchases a health plan on or after August 1, 2012, that insurer has to cover the additional forms of preventative care for free. It is very simple to understand.
The problem, however, is that many health insurers have decided to create “loopholes” that would allow them to get around the intent of the laws created as part of the Affordable Care Act. In short, the laws that were designed to help consumers are being twisted in a way that results in making consumers pay for health care treatments, screenings, and services that the federal government requires the insurer to provide for free, (because those things are considered to be preventative care).
One of the nasty things health insurers have decided to do is relabel health care like a colonoscopy or a mammogram as “diagnostic services”. So, when a person schedules a colonoscopy, their insurer tells them that it will be free to have done. However, while the person is sedated, the doctor could, potentially, remove a non-cancerous polyp. By the time the patient wakes up, the free preventative care has turned into a bill that can be more than $1,000.
Some states are working with Congress to push for more clarification about the preventative care rules. Specifically, they want to have it clearly stated that the removal of non-cancerous polyps is part of preventative care. I cannot imagine how a health insurer could realistically assume that the intent of the Affordable Care Act would be so insurers could find a sneaky way to generate an expensive medical bill while a person was sedated.
Image by Adria Richards on Flickr