Preventative Health Services--What Your Insurance Covers
Jeffrey A. Forrest, co-founder of Prevention on Purpose, is an advocate for preventative health care. With the adopted of the Affordable Care Act, insurance providers are now required to cover preventative health services in full. However, knowing what, exactly, is covered is key, so you don't end up with a hefty bill!
Published on: Mar 4, 2016
Transcripts - Preventative Health Services--What Your Insurance Covers
WHAT IS CONSIDERED “PREVENTATIVE”
BY HEALTH INSURERS?
Jeffrey A. Forrest, Co-Founder of Prevention on Purpose
THANKS TO A KEY PROVISION IN
THE AFFORDABLE CARE ACT
Most health insurers have now
adopted a policy of covering
preventative health care in full
Section 2713 requires private
health plans to provide coverage
for a variety of preventative
services without imposing cost-
This includes copayments,
deductibles, and co-insurance
Evidence-based preventative services can
improve health in that they can identify
illnesses earlier, provide more effective
management, and overall lower costs of
health when treating a condition that could
have potentially developed into something
more complicated and dangerous
THIS IS GREAT NEWS!
Considering a large portion of us weren’t even
getting the healthcare we need simply because of
FREE OF COST
…it’s important to know just
KNOW THE LAW… ALL OF IT
➤ The Affordable Care Act covers wellness exams, vaccinations,
cancer and other health screenings, as well as FDA-approved
contraceptives, entirely in most cases.
➤ However, health plans that were already in place when the
ACA took effect on March 23rd, 2010, are not required to fall
into compliance with this provision of the law, as those health
plans are considered to be “granfathered.”
➤ Pay attention to the details. While some services are deemed
preventative procedures, there may be a metaphorical “fine
print” you need to pay attention to. For example,
colonoscopies are considered a preventative service that is
covered in full under the ACA, if you are over the age of 50.
IT’S BEST TO BECOME FAMILIAR WITH
YOUR INSURANCE PLAN, AS WELL
➤ While private insurance providers are
required to follow the provisions of the
ACA, they are granted some wiggle room
when it comes to interpreting medical
guidelines, and they will use it.
➤ Become familiar with where your insurance
puts their metaphorical foot down.
➤ For example, while insurers are
required to cover all forms of FDA-
approved birth control pills, it
doesn’t mean they are required to
offer every pill offered, and often
will only provide generic types.
➤ Also, it’s wise to stay within the network of
your plan in order to make the preventative
service cost-free, as seeking service from a
doctor outside of your network will cost
MAKE YOUR INTENTIONS
When you go in for a preventative check up or
screening, make that clear when you’re making the
appointment. If an existing health issue is brought up
during the same visit, chances are you could get billed
for it despite the preventative service being free of cost.
…TO DEAL WITH
Pay careful attention to any bills received after
going in for a preventative service. If you’re
getting charged for something you think you
shouldn’t, question it, as often it’s a simple billing
error that requires a phone call to remind billing
your visit was for preventative purposes. If that
doesn’t work as seamlessly, contact your insurer,
as often they will be able to step in on your behalf
and resolve the issue. If you feel like you’re
jumping through hurdles dealing with the billings
department and your insurer, there is an option for
you to file an appeal with your health plan. While
it may seem tedious, health care is a human right,
and affordable health care is required to us by law.
TAKING THE STEPS TO UNDERSTAND BOTH THE PROVISIONS OF THE
AFFORDABLE CARE ACT, AS WELL AS THE INTRICACIES OF YOUR
INSURANCE PLAN WILL ONLY BRING CLARITY TO THE CONTROL
YOU HAVE OVER YOUR OWN HEALTH AND WHAT YOU CAN DO IN
ORDER TO MAKE SURE YOU’RE LIVING THE BEST LIFE POSSIBLE.
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