Why Was Covered Preventive Care Denied?

I am a male who is 51 years old and a father of three teenagers.

I went through a preventive Colonoscopy and Endoscopy after my gastro-enterologist discussed over the phone the procedure with the assigned doctor from Coventry, my insurance provider, prior to the procedure being performed.

Now, Coventry is denying the claim. They are not complying with the Affordable Care Act. The reason I went through the procedure because of their approval and because of the information on the Affordable Act. If they did not approve it, I would not have done it.

Do you have any resources that I can use to demonstrate to Coventry (or any insurance provider) that this is incorrect?

Leave a comment

We'll never share your email with anyone else.

1 2 3 4 5

This site uses Akismet to reduce spam. Learn how your comment data is processed.

what if a preventive services is done by an out of network provider should if still be covered at 100% can the patient be balanced bill?


No, not at all. You should always call your insurer before getting a service to make sure it is in-network (or if not if the out-of-network covers it or if they can make an exception, etc).


I am 63 and also got a preventive Colonoscopy and Endoscopy. (15 years + since my last.) The doctor found and removed from my colon 2 small polyps which tested benign. Insurance paid @ 2/3 of the surgical center bill, and I paid 1/3, and I have no problem with that as I figured only the colonoscopy was a covered preventive. But we are still haggling over the doctor’s bill, and the insurer expects me to pay 100% of the anesthesiologist, and 100% of the biopsy. This because the 2 polyps were found and removed-to their way of thinking that makes it not preventive but diagnostic, and they changed the code the doctor sent in. To me, shifting costs based on findings is a DIS-incentive to preventive care. (Added costs for added work maybe, but not the whole thing!) So, what does the official concept of preventive include? Many thanks. (It is especially silly to shift the anesthesiologist cost. He would do exactly the same things no matter what the doctor was doing.)


This has been one of the areas of the law the has caused a lot of confusion. Preventive treatments are covered at no out-of-pocket cost, while other essential benefits are covered too (but typically with cost sharing). When a person goes in for a preventive treatment distinguishing between what aspects are preventive, what are essential benefits, and what are somehow uncovered out-of-network treatments is tricky. Is that medicine you need to take two weeks before surgery covered? Is that a diagnostic test and not a preventive test? Is this a doctors visit or a preventive visit? What is the difference anyway? Normally the best way to get things to swing in your favor is by appealing the insurance companies decision and hounding them to cover the tests as preventive. The stuff that is not covered at no out-of-pocket costs should at least be counted toward your deductible and out-of-pocket maximum. The best answers we have to all these questions and the best lists of what is covered we have found are all complied here: https://obamacarefacts.com/obamacare-preventive-care/

We are always looking for more insight and to have more people share their experience with preventive services. So anyone is welcome to comment more below.

ObamaCareFacts is a free informational site. It's privately owned, and is not owned, operated, or endorsed by the US federal government or state governments. Our contributors have over a decade of experience writing about health insurance. However, we do not offer professional official legal, tax, or medical advice. See: Legal Information and Cookie Policy. For more on our company, learn About ObamaCareFacts.com or Contact us.