Putting Their Money Where Their Mouths Are

Insurance coverage for preventive services is changing with the new health care act. Our insurance plans have been crisis-oriented for coverage and reimbursement of preventive services. For instance, no problem paying for your hip fracture but not your bone density screening. Let’s see, one cost the system about $40,000 for surgery and post surgery care while the other cost the system about $140 for a DXA scan (bone density test).

Does that make sense? A resounding “NO!”

Fortunately, changes announced yesterday are in place to start September 23, 2010. All recommended screenings by the U.S. Preventive Services Task Force (USPSTF) with top grades of “A” and “B” in their rating scale will be covered. According to healthcare.gov these preventive services “must be covered without your having to pay a copayment or coinsurance or meet your deductible, when these services are delivered by a network provider.”

As posted in our July 5, 2010 blog “When to Screen?” the USPSFT is changing their screening criteria for osteoporosis. Their final report is due out later this year after time for public input. For now, the following is in place for osteoporosis screening:

The U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis in women ages 65 years and older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old woman who has no additional risk factors. This is a grade B recommendation.

View a complete list of covered preventive services.

The good news is that health care coverage is moving in the right direction.

-Diane L. Schneider, MD
Source: healthcare.gov
Image: courtesy of vichie81 /FreeDigitalPhotos.net