topic Re: Medical Insurance Question in Community Chat

Medical Insurance Question

Lipstickdiva — Wed, 07 May 2014 16:27:29 GMT

I cannot seem to find the answer to my question anywhere. I have health insurance through DH's employer with Medical Mutual. I recently went for my yearly women's exam and mammogram.

I just rec'd my EOB and it indicates that I am responsible for the $15.00 office visit co-pay and I am responsible for paying the entire allowed amount for my mammogram because it will be used towards my deductible.

In the grand scheme of things, it's not a lot of money and I know I am very lucky but for some reason, I thought that under the new health care reform, there was to be no co-pay or deductible for the type of services I had done. Any follow-up for the preventive care would be my responsibility though.

Re: Medical Insurance Question

straykatz — Wed, 07 May 2014 16:31:58 GMT

Contact the insurance provider to find out why they are not covering a mamo.....and also contact the compnay who did the mamo to make sure they coded it correctly...incorrect coding is often the cause of things like this.

Re: Medical Insurance Question

pistolino — Wed, 07 May 2014 16:32:14 GMT

You'll need to check with the insurer, but you are correct, those items should have been paid 100% by the insurance company.

I have a $3000 deductible on my employer's insurance, but the GYN exam and screening mammo were no cost to me (no co-pay either). The followup testing was 100% on me, though.

Re: Medical Insurance Question

Lipstickdiva — Wed, 07 May 2014 16:35:11 GMT

Thank you very much. That's what I thought. I did notice the dr. visit was coded as preventive care. I didn't pay attention to the mammo but I will look and call.

I appreciate your help.

Re: Medical Insurance Question

redtabby — Wed, 07 May 2014 16:38:23 GMT

Yes, both should have been covered 100% if you went to providers in your plan. My favorite mammagraphy center is not in my plan.

http://clearhealthcosts.com/blog/2013/05/arent-all-mammograms-free-because-of-the-affordable-care-act/

http://aspe.hhs.gov/health/reports/2012/ACA&Women/rb.shtml

Re: Medical Insurance Question

phillysher — Wed, 07 May 2014 16:39:07 GMT

We now have a deductible, whereas since my employer signed with Cigna years ago, we never had a deductible, just a co-pay and the rest was covered. Now premiums have gone up, we have deductible and co-pays have increased. I have 2 insurance policies and still rec'd a bill from a specialist I had seen months ago.

Re: Medical Insurance Question

pistolino — Wed, 07 May 2014 16:42:42 GMT

On 5/7/2014 LipstickDiva said:
Thank you very much. That's what I thought. I did notice the dr. visit was coded as preventive care. I didn't pay attention to the mammo but I will look and call.

I appreciate your help.

No problem. I'm glad you looked at your EOB, some people never bother and they just pay bills as they come in. I think we're going to see a lot of these errors over the next year as all the providers and insurers try to get on the same page about preventative care.

Re: Medical Insurance Question

Lipstickdiva — Wed, 07 May 2014 16:56:54 GMT

I contacted our insurance. DH's plan is ""grandfathered in"" so his employer isn't required yet to move over to the new health care reform benefits. That will probably happen sometime this year but it hasn't happened as of yet.

Re: Medical Insurance Question

kittymomNC — Wed, 07 May 2014 17:00:18 GMT

Just some additional info some people may be interested in:

ACA provisions you can already take advantage of:

Free preventative care for women
As of Aug. 1, 2012 insurance plans are required to cover free annual physicals for women, HIV testing and counseling, HPV DNA testing, screenings for gestational diabetes, screening and counseling for domestic violence, breastfeeding medical support, counseling for sexually transmitted infections, and FDA-approved contraceptive products.

Free mammograms and colonoscopies

Since September 2010, insurers have been barred from levying out-of-pocket costs on patients receiving mammograms and colonoscopies, two of the most widely used forms of preventative care.

HOWEVER, MANY EMPLOYER PLANS WERE "GRANDFATHERED" AND DON'T HAVE TO MEET THESE CRITERIA YET. You need to call your insurance company or ask your employer if you are in a company health insurance plan and you are charged anything for these services. Here's some information from Kaiser. You can get more info from Kaiserhealthnews.org:

With all the uproar from people whose individual health insurance policies are being cancelled, you may have heard the phrase “grandfathered plans.” This refers to a part of the Affordable Care Act that permits some health plans – those offered before the ACA passed - to be exempt from some of the law’s rules and protections. The idea was that the exemptions would help smooth the transition and allow businesses and individuals to keep current policies without having to make substantial changes.

While the attention lately has focused on individual policies, if you get your insurance from your employer, there’s a good chance that you are in a grandfathered plan, and that means some of the changes the law requires do not affect you — yet. More than a third of all Americans who get insurance through their jobs are enrolled in such plans, although that number is expected to decline every year.

Consumers should know the status of their plans since that may determine whether they are eligible for certain protections and benefits created by the health law. For example, an employee at a large company may wonder why his job-based insurance doesn't include the free preventive services he's heard about. To answer questions like that, you must understand the status of your plan and how grandfathering works.