Understanding Preventative Care and Blood Work Coverage

Understanding Preventative Care and Blood Work Coverage

The Affordable Care Act (ACA) has brought about significant changes in the healthcare landscape, including expanded coverage for preventative care. However, there have been some recent instances where certain preventative services, such as blood work, have no longer been covered under ACA plans. Let’s explore this topic further.

What is Preventative Care?

Preventative care refers to healthcare services aimed at preventing or detecting chronic diseases or conditions before they become serious. The ACA mandates health insurance carriers to cover a comprehensive list of preventative services at no cost to the insured.

Blood Work and Preventative Care

Blood work is often considered a preventative measure as it can detect health issues early on. However, not all types of blood work are classified as preventative under the ACA.

• Covered Blood Work:

Cholesterol screenings
Blood pressure checks
Diabetes screenings
Colorectal cancer screenings
Mammograms

• Non-Covered Blood Work:

Blood tests for general health evaluations
Tests ordered specifically to diagnose a suspected illness or condition

Why May Blood Work Not Be Covered?

There are several reasons why blood work may not be considered preventative under ACA plans:

Improper Coding: Healthcare providers need to code blood tests appropriately as preventative, otherwise, insurance companies may deny coverage.
Diagnostic Tests: If blood tests are ordered specifically to diagnose an illness, they are not considered preventative.
Health Plan Design: Some health insurance plans may exclude certain types of blood work from their preventative coverage.

What to Do if Your Blood Work Is Not Covered

If you receive a bill for blood work that you believe should be covered under your ACA plan, you should:

Review Your Plan Documents: Carefully read your policy to determine whether the specific blood test is covered.
Contact Your Health Insurer: Discuss the situation with your insurer and inquire about the reason for the denial.
Request a Coding Review: If you believe the blood test was coded incorrectly, you can request that your healthcare provider or insurer review the coding.
Seek Professional Assistance: If you are unable to resolve the issue on your own, consulting with a licensed insurance agent can provide additional guidance.

Understanding the scope of preventative care coverage under ACA plans is crucial. If you have any questions about blood work coverage or other preventative services, it is advisable to contact your health insurer or seek professional assistance to ensure you are receiving the coverage you are entitled to.