Do All ObamaCare Plans Have to Cover Lung Cancer Screening?
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My primary care physician informed me that Lung Cancer Screening is covered. All health insurance must pay for the fee. Is that true?
My primary care physician informed me that Lung Cancer Screening is covered. All health insurance must pay for the fee. Is that true?
Skartwed
To all concerned,
I am in the process of trying to find all pertinent information on this procedure in order for it to be covered as preventative at 100% by my insurance benefits. A few things I have found as required criteria
1. A WRITTEN ORDER from physician including 5 required fields (not listed here; you can find online)
2. Often a pre-certification with insurance company or designated third party by ordering physician
3. All criteria met and documented including a counseling session with doctor that includes recommendation for procedure, risks involved, cessation intervention, etc (CPT-G0296)
4. CPT (insurance) code G0297 for LDCT lung cancer screening
5. ICD codes must coincide with need for procedure (.ie Z87.891 and/or Z72.0 and there may be other applicable codes)
6. Must use a radiology center certified for this specific procedure
I agree that we should not have to research this or any procedure this thoroughly to obtain government mandated preventative care.
Even after all this effort to ensure coverage, I still am not certain my insurance will pay as required until I receive my explanation of benefits statement.
I suggest anyone that has been denied 100% preventative coverage, review and update your claim and with assistance from physician or facility, resubmit your claim.
Good Luck!!!
JANE CAGNEY
I got a lung cancer screening in July also based on the fact that this screening is classifed by the USPSTF as a “B” rated recommended screeening and my insurance documents state that all A and B USPTF recommended screening would be covered with no out of pocket costs. I meet all of the required criteria. Guess what I am now fighting a $2500 bill for the screening which I can ill afford to pay. After 5 emails and 8 telephone calls with my insurance provider, my doctor, the hospital radiology department that billed the test, I still cannot get confirmation it’s covered or if it’s a billing code error! It’s not right that we as patients and consumers cannot accurately determine ahead of time what things are covered, what the exact cost will be, and know that the correct billing codes were used.
ObamaCareFacts.com
That is awful. I would always talk to your insurer first, but I won’t victim shame. This is largely an abuse of loopholes and a sign more reform is needed.
Jayne
What exactly does “in most cases” mean?
ObamaCareFacts.com
It means that when we get down to the nitty gritty of the number of times you access a service and the reasons a service is being preformed little loopholes start popping up. We aren’t experts in how health plans are administered, just the basic rules set out by the ACA. So we always tread lightly when discussing specific covered services. Always refer to the insurer and ask them directly.
Kevin Corcoran
I was stuck with an over $800 bill as well. Being mislead that a CT scan for lung cancer was now a zero cost option. After all, the basic function of the ACA was to put rules in place for health care providers and insurance companies. Yet your reply is to check with the insurance company and they will decide what the customer pays. This is a big contradiction to the basic premise of the ACA.
Jayne Brownlee
I based my decision to get screened for lung cancer on this comment and as recommended for high risk individuals. The cost of the test was covered only under my deductable by my Ca Blueshield plan, leaving me with an unexpected $890 bill. Some preventative tests cost nothing and other, potentially more valuable tests, are the full responsibility of the member. Now what do I do: continue having this
extraordinarily expensive test annually to monitor progression of spots as my doctor recommends.
This answer is just wrong and should be reworded. Also, a member should be able to forgo a np cost preventative test and apply those dollars to another. I would have skipped the free mammogram in favor of the lung scan in a minute.
Jayne Brownlee
I based my decision to have a low dose ct scan of my lungs, clearly deemed medically necessary under rules found elsewhere, only to be billed the full amount by blue shield of ca (silver plan). My doctor understood this to be true too.
Why is it so difficult to find accurate cost and coverage information? A very unwelcome added expense.
It simply should not be legal to only be able to find the price of ANYTHING only after the fact. The current pat answer is “just plan on your maximum deductible”. or should that be “maximum out of pocket”. Neither of these explanations is acceptable period. Medical costs are between 10-20% of my AGI.
ObamaCareFacts.com
You should absolutely know most of the terms of a health insurance contract before you buy. Not sure what you are implying here? Are you shopping through Covered CA?