Watch out. Don’t assume that the free preventive care services to which you are entitled under the Affordable Care Act (ACA) will not cost you a bundle. Samantha Liss reports for KFFHealthNews on how a free colonoscopy service turned into a huge bill.
One couple with coverage through the Illinois state health insurance exchange were charged $600 for their “free” preventive care colonoscopies. Of course, the health care facility did not bill them for their colonoscopies, since that would be illegal.
Rather the health care facility, seemingly in cahoots with the couple’s insurer, billed the couple for “supply trays.” The story exposes how providers and insurers game the system at the expense of patients in our current out-of-control health care system.
Here’s what happened: At 45, the couple went to a facility for what they believed to be free colonoscopies. The bill for the two procedures was $4,068. The insurer discount brought the bill down to just under $800—the insurers’ cost.
Afterwards, the couple were each billed $600 by the facility for “supply trays.” Their insurer brought their charges down to $250 each. But, their bill still totaled $500 for the two “free” colonoscopies and the couple appealed.
What happened? The story suggests that the gastroenterology practice, owned by a private equity company, did an end-run around the ACA. It does not make clear whether charging for supply trays is legal, although it’s hard to believe it is. It also appears that the couple’s insurer was in on the game since the gastroenterology practice had arranged this charge with the couple’s insurer. The more revenue the gastroenterology practice can get from patients, the less it needs to get from their insurers.
The couple filed complaints. Federal law does not protect people in these cases, even though the ACA is federal law. States are in charge. The couple were at the mercy of their insurer.
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