My spouse is 40 y/o and had a colorectal screening performed. She spoke with the doctor and insurance company and was told that there would be no out of pocket cost because it’s a preventative care procedure, and she is considered “high risk” since her father died of colon cancer at a young age. The procedure went fine with no issues.
Aetna posted an EOB to my account indicating I would be responsible for about $1500 in out of pocket (facility, doctor, anesthesia). I called Aetna and they said while the procedure was *covered*, it’s not zero cost because my wife is only 40 and not 45. I am waiting on the actual bill before escalating and trying to get it sorted out in my favor.
But here’s my fundamental confusion:
What is the *actual law* regarding zero out of pocket for preventative care?
While it makes sense to me that there are standards like what age something like a colorectal screen is needed, at the point where the insurance company has determined that the screen is *covered*, then how does this not clearly fall under the rule about no out of pocket? Like I would understand if Aetna said, nope, you are too young for us to cover this as a routine preventative procedure. But in this case they covered it, and it’s clearly preventive. She wasn’t referred for the procedure due to any ongoing health issue, and the screening came back 100% clean.
submitted by /u/Exacta7
[link] [comments]
My spouse is 40 y/o and had a colorectal screening performed. She spoke with the doctor and insurance company and was told that there would be no out of pocket cost because it’s a preventative care procedure, and she is considered “high risk” since her father died of colon cancer at a young age. The procedure went fine with no issues. Aetna posted an EOB to my account indicating I would be responsible for about $1500 in out of pocket (facility, doctor, anesthesia). I called Aetna and they said while the procedure was *covered*, it’s not zero cost because my wife is only 40 and not 45. I am waiting on the actual bill before escalating and trying to get it sorted out in my favor. But here’s my fundamental confusion: What is the *actual law* regarding zero out of pocket for preventative care? While it makes sense to me that there are standards like what age something like a colorectal screen is needed, at the point where the insurance company has determined that the screen is *covered*, then how does this not clearly fall under the rule about no out of pocket? Like I would understand if Aetna said, nope, you are too young for us to cover this as a routine preventative procedure. But in this case they covered it, and it’s clearly preventive. She wasn’t referred for the procedure due to any ongoing health issue, and the screening came back 100% clean.
submitted by /u/Exacta7 [link] [comments]Read Morer/HealthInsurance