Consumer representatives say they think that health insurers are denying too many claims for preventive services that are supposed to be covered without co-payments or other out-of-pocket costs for the patients.
The reps, who have official appointments to speak for consumers' interests at meetings of the National Association of Insurance Commissioners, are asking state and federal regulators to conduct detailed reviews of how insurers communicate with patients and providers about "free" basic preventive care services.
The reps also want regulators to collect samples of health plan enrollee files and look at how the plans handle preventive services claims.
Conducting detailed analyses of how plans handle claims "is the only way to understand whether plans are abiding by coverage and cost-sharing requirements," the reps say in a new report. The reps are preparing to present the report Saturday in Seattle, at an in-person meeting of the NAIC's Consumer Liaison Committee.
What It Means
The consumer reps are talking about the coverage for the kinds of services that clients with high-deductible health plans and health savings accounts can get covered before they meet their plan deductibles.
The reps' work could affect the number of billing headaches HSA users face when they go in for routine checkups, mammograms and cholesterol checks.
Preventive Services
The Affordable Care Act requires coverage sold since 2010 to cover a basic package of high-value preventive services "for free."
