How is your practice handling expanded preventive care?

A few months ago, I was elated to receive a piece of good news from my health insurance company: No more copays for most preventive care. At a minimum, that's now about $100 a year savings for my family on annual checkups, not counting other qualified screenings or services no longer subject to cost-sharing. I was surprised, though, that the tone of the brief letter I got describing the change was decidedly less enthusiastic.

It started off no different from one of the typical 'tough luck' correspondences our society has grown accustomed to receiving from insurance companies. After all, "Please be advised that your benefits have changed," usually means you're going to be getting less and paying more. And if I weren't familiar with the lingo, I'd certainly think the message of no more cost-sharing meant that the payer was the one no longer sharing costs. With communication like this, no wonder half of Americans are still confused about how they'll be affected by health reform.

Nonetheless, it was nice to not have to pull out any plastic other than my insurance card at my most recent well visit. The receptionist was well aware I owed nothing and waved me off to the waiting room with a smile.

That was a month or so ago, and on a rare occasion I wasn't distracted by my usual pint-sized companions. So when the receptionist at the pediatrician's office asked for the usual copay at my 4-year-old's checkup, I handed over the debit card and signed without pause. It wasn't until we got far enough away to ponder a lunch out for shots-related bravery that I realized I'd just essentially given away $25.

When I spoke to a representative from the billing department less than an hour after leaving the office, the voice on the other end of the phone didn't sound apologetic or even surprised. I was somewhat wearily, rather nonchalantly told that the money would eventually appear as a credit on my account with the practice, after the claim came back from the insurance company.

Time will tell whether that credit ever actually appears or whether I have to fight for it--if I even remember, the next time I reach into my wallet out of reflex.

Now, I love this office, and don't really see this one infraction as something to make a huge fuss over. I would rather have my $25 now than later, but am going to give the organization the benefit of the doubt that it's working on the problem.

My message to you, however, is to make sure your staff are on the ball with this change. Other patients will not be nearly as understanding. And it's not fair to use the likelihood that roughly half of them probably think their coverage has decreased rather than increased to buy you time. It says right on my insurance card, and probably most others, that my copay for preventive care is $0. So even though staff may justifiably not be able to keep track of which health plans are and are not grandfathered into the benefit (or have chosen to modify coverage now anyway), now you have even more reason to check patients' insurance card at every visit.

Even more importantly, if you haven't done so already, devise your strategy for handling situations in which preventive services trigger procedures. Again, I know it's confusing. But at the very least, patients should be notified of the possibility that a biopsy or polyp removal could result in a bill. As we've seen with the case of facility fees and other out-of-pocket expenses, it seems to be the surprise that irks patients even more than the bill itself.

Now, I doubt my personal experience with two offices and one health plan is representative of the rest of the country. How has your office been handling the issue of preventive care? Has the information you need been available when you need it? If the transition has been smooth, how have you gotten there? - Deb