Are Lab Fees Included For Free Under ObamaCare?
Under women’s well visits are the lab testing fees included? I just received an explanation of benefits from my insurance company, CareSourceJustForMe. It states that I will owe $209.25 for lab services associated with my pap smear because it all went to deductible.
Wellness visits and key preventive care are covered with no out-of-pocket costs, but some related services aren't covered without cost sharing.
Lab tests should be covered, but perhaps some related lab service isn't. The best bet here is to simply check with the insurer and ask why a specific item wasn't covered. It could be a matter of how things were coded, or it could be that this service is an in-network benefit, but not a free preventive service. If it was coded wrongly it can be recoded by the lab or doctor and the bill can be resubmitted to the insurer at no cost to you.
The confusion over exactly what is covered has been a common issue with a lot of the wellness and prevention stuff. It would be hard for anyone without a medical background to be able to differentiate between "wellness or prevention" (covered) and "evaluation or monitoring" (not covered). It's confusing that a drug you need to take before a test has a copay, but the test doesn't, but then some of the lab services needed to complete the test do. It confusing to go into a wellness and prevention visit, then ask about an ongoing medical issue, only to be charged or told you need to make a separate appointment. These rules make sense on paper, and of course not everything can be "free", but it does seem like more of an effort can be made to clarify this for people and manage expectations.
A good tip would be to double check on what is and isn't covered before you go in to any appointment (in emergencies, you should just go first and deal with billing later). By double checking with the doctor and insurer before getting any work done you ensure that you can make the right choices not just for your health, but for your wallet.
Below are the services that are covered for free for women, you can click on any one to get more information.
- Anemia screening on a routine basis for pregnant women
- Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
- Breast Cancer Mammography screenings every 1 to 2 years for women over 40
- Breast Cancer Chemoprevention counseling for women at higher risk
- Breastfeeding comprehensive support and counseling from trained providers, and access to breast feeding supplies, for pregnant and nursing women
- Cervical Cancer screening for sexually active women
- Chlamydia Infection screening for younger women and other women at higher risk
- Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
- Domestic and interpersonal violence screening and counseling for all women
- Folic Acid supplements for women who may become pregnant
- Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
- Gonorrhea screening for all women at higher risk
- Hepatitis B screening for pregnant women at their first prenatal visit
- HIV screening and counseling for sexually active women
- Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older
- Osteoporosis screening for women over age 60 depending on risk factors
- Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
- Sexually Transmitted Infections counseling for sexually active women
- Syphilis screening for all pregnant women or other women at increased risk
- Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
- Urinary tract or other infection screening for pregnant women
- Well-woman visits to get recommended services for women under 65