Say you have a patient who comes in for a colonoscopy screening--one of several preventive services now available to patients without cost-sharing--which results in the prompt removal of a polyp or two. You've now performed a procedure, not necessarily covered, on a patient who may have come in expecting the visit to be free. If this scenario has caused confusion and frustration in your practice, you're not alone.

In fact, Dr. Roland Goertz, president of the American Academy of Family Physicians, told Kaiser Health News that colonoscopies are just the most obvious example of this conundrum, pointing out that a preventive exam could just as easily trigger excision of a skin lesion or biopsy of a breast lump.

As of now, patients who belong to Medicare and at least two large private insurers, Kaiser Permanente and Health Net, are on the hook to pay for treatments that result from preventive screenings. Although the regulations released last July on the new preventive care benefits permit health plans to impose cost-sharing in this circumstance, seven major insurers--including Aetna, Cigna and Humana--said they would not charge enrollees. Medicare is waiving the deductible for its beneficiaries, but charges patients a copay of $186 plus 20 percent of the doctor's fee, KHN reports.

While patient and physician advocacy groups continue to battle about what should be covered by whom, practices should become aware of the current policies of the health plans they contract with and pass that information on to patients to avoid surprise bills.

To learn more:
- read the article from Kaiser Health News

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