CHARLOTTE, N.C. (WBTV) – Some patients in the Charlotte area raised concerns after receiving letters in the mail from healthcare providers that listed what can and cannot be addressed during a preventative care visit.
Rachael Nord says she received a letter from Atrium Health prior to her annual exam. The letter lists services that would be covered during a preventative care visit. It also lists a number of services that would not be covered during that exam. The letter explained that if those services were addressed, Nord may receive another charge or she may have to make a second appointment to address those issues.
“Which was understandable for some of it, including things that weren’t related to the specific doctor I was visiting, but then there were a few things on there that I thought was a given to be able to talk about with that doctor. So, I was surprised,” Nord said.
Nord took her frustrations to Facebook and asked if anyone else had received a similar letter. Her post received more than 100 comments with similar stories and concerns.
Stacey Dixson responded to the post. She told WBTV it made her question what she brings up to her doctor during visits.
“I feel like I shouldn’t have to walk out of there and worry about the tally of my bill,” Dixson said. “So that would cause me to maybe not ask questions that I have concerns about.”
WBTV contacted Atrium Health and other healthcare providers in the Charlotte area. Atrium Health is not unique in notifying patients of what’s covered and what is not. A spokesperson for Novant Health told WBTV, it too has sent similar notifications to patients prior to preventative care visits.
A spokesperson for Atrium Health says the hospital system has been sending letters like this one for at least five years and it is not exclusive to OB/GYN services. In an email exchange about the letter, the spokesperson sent the following information:
A patient can certainly ask any question they would like. If they come in for a well/annual visit, it is coded as such. This is a positive letter sharing with patients what constitutes an annual visit so they are not surprised by any charges that their insurance/health plan may not cover if there are any diagnostic charges,” Ashley Sherry Brown with Atrium Health communications said. “We’ve been sending them for at least 5 years and these are sent out for all types of preventive wellness exams (ie, yearly physical, child well appointment, etc.). According to the Affordable Care Act, insurance companies are legally obligated to cover preventive wellness exams at 100%. There are certain tests that are covered that are federally mandated, but can differ from insurance plan to insurance plan. We are simply helping patients to be aware that their insurance plan will cover some items at 100%, but others may not be covered 100%, depending on their insurance.”
Atrium Health recommends patients check their health plan in advance to know the preventative services insurance will or will not cover.
WBTV also reached out to Blue Cross Blue Shield of NC about the notification. In response to our questions about why gynecological issues wouldn’t be covered under an annual exam at a gynecologist’s office, the insurance provider released the following statement:
Providers are responsible for determining if something is billed as preventive or non-preventive. Blue Cross NC processes claims based on how providers submit them to us. We cover preventive services as defined by the Affordable Care Act (ACA) at 100 percent if that’s the way the claim is submitted. Services that are not considered to be preventive under the ACA will process in accordance with the member’s benefits.”Austin Vevurka with BCBSNC
Vevurka also shared the following resources:
- We cover required preventive services as recommended by four expert medical and scientific bodies – the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), the Health Resources and Services Administration’s (HRSA’s) Bright Futures Project, and HRSA and the Institute of Medicine (IOM) committee on women’s clinical preventive services.
- More information on preventive benefits specifically for women is here: https://www.healthcare.gov/preventive-care-women/
- More information on preventive benefits is here: https://www.healthcare.gov/coverage/preventive-care-benefits/
Copyright 2020 WBTV. All rights reserved.
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