COLORADO —
The new provision of the federal health law that waives cost sharing for women’s preventive health services may be a mandate on insurance companies, but it’s providers who are complaining about its burden.
That’s because not all women are eligible for the cost sharing waiver at the same time. The rule went into effect Wednesday, but only for plans that are new or renewing after that date. Women with “grandfathered” plans that don’t renew for months or even years still face co-pays until that time.
Anders Gilberg with the Medical Group Management Association, a national organization representing doctors’ groups, said that means practices will likely have to call each patient’s insurance plan when they show up for a preventive visit.
“The way you have to go about checking eligibility for each plan would be different. There’s not one way, one portal, to check it,” he said.
The alternative is charging every patient a co-pay and then issuing a refund, which is poor customer service and wastes staff time.
Simply waiving all co-pays for preventive visits isn’t an option, Gilberg says, because that would violate providers’ contracts with plans that require co-pays.
Another glitch providers expect is one they ran into when the law waived co-pays for some Medicare services. Patients made appointments for preventive screenings, but then asked providers to deal with other conditions that require co-pays, generating bills patients weren’t expecting.
Gilberg says practices are trying to educate patients about what preventive visits do and don’t cover, and encouraging them to find out if their health plan is grandfathered before they show up expecting a free visit. That itself is a burden on practices, he notes. He says what practices really want is better information technology, so front desk staff can simply swipe a patient’s insurance card and have pertinent billing information at their fingertips.
* This story is part of a collaboration that includes Colorado Public Radio, NPR and Kaiser Health News.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.
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