Wall Street Journal Examines Patients’ Confusion Over Coverage of Preventive Exams
As employers increasingly offer no-cost preventive care as a means of controlling health costs, some people under such plans are being charged for services not deemed preventive by the insurer, the Wall Street Journal reports. According to Watson Wyatt Worldwide, 72% of large employers in 2009 cover 100% of preventive care -- such as physicals, colonoscopies or mammograms -- for employees, an increase from 55% of large companies in 2008. The Journal reports that the charges often result from billing errors or from a physician's office being unaware of an insurer's procedures. Charges that are the result of billing errors often can be reversed. However, others -- such as a test or treatment not being defined by the insurer as preventive -- force some patients to "wage a protracted battle" to get the charges reversed, according to the Journal.
When unexpected charges appear on patients' bills, physicians and employers often receive complaints but they have little control over how insurers classify treatments. The Journal reports that patients can prevent being charged for preventive services by checking with their insurer before seeking care; asking for specific, covered screenings and treatments at physicians' offices; reviewing explanation of benefits forms supplied by insurers; asking supervisors at insurers to review disputed claims; and seeking help from employees in company human resource departments (Wilde Mathews, Wall Street Journal, 5/21).