Making the Most of Your Preventative Care Benefit
Insurance companies may be increasing patient payments for medical services through higher deductibles and copayments but they are not entirely heartless. In order to encourage you to maintain good health many companies now offer full coverage for preventative care. Preventative mammograms, colonoscopies and other highly entertaining medical procedures are absolutely free to the insured.
Now, unless you trust health insurance companies a lot more than Wonks Anonymous does, you may be asking: "Is there a catch?" Alas there is: For the health insurance companies, a test is only preventative if there is absolutely no specific indication that the person who is being tested might have the condition being tested for.
A mammogram for a thirty year old women would be covered, provided that the woman is not getting the mammogram because she has felt a small change in her breast. A fifty year old man can get a free colonoscopy, unless he shows some symptom, no matter how slight, that might indicate colon cancer. Note: The symptoms in question can include a family history of cancer in either of these cases.
Health insurance companies carefully examine the diagnoses entered on claims for preventative services and any indication that the test is done for any reason, other than standard preventative care, is enough to disqualify it for the preventative benefit.
Wonks Anonymous does not encourage patients to lie to their doctors. He does believe that they should inform their doctors of the provisions of their health insurance policy as this has now become vital data for medical decision making. Wonks Anonymous does not know what doctors should do when submitting claims or orders for preventative services. He does believe that they should take the financial impact of such claims on their poorer patients into account.
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