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Preventive Medical Care Can Come With Unexpected Costs

Insurers still charge copays for some contraceptives.
Laura Garca
Insurers still charge copays for some contraceptives.

Preventive health care services are supposed to be covered under the Affordable Care Act so that people don't have to pay out of pocket to get recommended screening tests. But some people are discovering that these supposedly free services can be costly.

Take colonoscopy. The procedure is recommended for people age 50 and older by the U.S. Preventive Services Task Force, and thus should be covered under the law. But there's a hitch. Although insurers generally pay for the procedure itself, they may not pick up the hospital facility fee or the anesthesia charges, leaving patients on the hook for sometimes more than $1,000 in additional charges. Talk about a rude awakening.

Contraception is another sticky area. Most health plans are supposed to pay for all methods of birth control approved by the Food and Drug Administration without charging women anything out of pocket. But some insurers have not been paying for some forms of contraception, according to a recent study by the Guttmacher Institute, a sexual and reproductive health research and education organization.

Some insurers weren't paying for the contraceptive ring or patch, the study found, saying that because they use the same hormonal ingredients as some birth control pills they're not actually different methods of birth control. Other insurers are excluding the newest emergency contraceptive, ella, from no-copay coverage.

"The pill, the ring and the patch are different types of hormonal methods," said an HHS official in an e-mail. "It is not permissible to cover only the pill, but not the ring or the patch."

Health plans are committed to complying with the law, says Susan Pisano, spokeswoman for America's Health Insurance Plans, a trade group. But there may be some variability in coverage, she says, when the law doesn't specifically spell out what must be covered without copays or deductibles.

The Department of Health and Human Services says it's working on it. "We continue to monitor how the preventive services provisions are being carried out, and we are working with stakeholders to ensure they understand our guidance and to offer further clarity to them when needed," says spokeswoman Joanne Peters.

In the meantime, experts advise that if you get a bill for a preventive service or something associated with it, don't just pay up: File an appeal with your health plan.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Michelle Andrews