The U.S. Department of Health and Human Services (HHS) made the Patient Protection and Affordable Care Act (PPACA) basic preventive services package famous by putting a controversial mandate — for “free” birth control benefits — in the package.
Consumer groups say patients are having trouble using the other, less controversial benefits in the package, such as access to checkups, vaccinations and some cancer screenings.
The issue came up last week in Louisville, Ky., at the summer meeting of the National Association of Insurance Commissioners (NAIC). The NAIC/Consumer Liaison Committee — a panel that brings state insurance regulators together with representatives from consumer groups — heard a presentation by Adam Linker of the North Carolina Justice Center, Kathleen Gmeiner of UHCAN Ohio, and Stephanie Mohl of the American Heart Association/American Stroke Association.
“Consumers and insurance agents report that they are still seeing charges for preventive services,” according to a written version of the speakers’ presentation. “Consumers are not sure how to resolve the problem.”
Drafters of PPACA added the preventive services section in an effort to make sure that all enrollees in non-grandfathered major medical plans have easy access to basic cost-effective preventive services. The HHS secretary is supposed to develop the list of services in the package with help from the Institute of Medicine and the HHS Health Resources and Services Administration (HRSA). Issuers are supposed to cover the services without imposing deductibles, co-payments, coinsurance or other cost-sharing obligations on the patients.
In some cases, providers surprise patients with bills for other services bundled with the “free” services. In other cases, providers and insurers leave consumers with bills for the preventive services.
It’s not always clear who has the authority to enforce the PPACA preventive services coverage requirements, the consumer group reps said.
“Departments of insurance can help convene providers, carriers and agents to resolve problems,” according to the reps.