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ACA guidance closes prevention loopholes

NEWS IN BRIEF — Posted March 11, 2013

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The Dept. of Health and Human Services in new guidance makes it clear that patients won’t have to face unexpected cost-sharing for certain preventive services under the Affordable Care Act, according to cancer patient advocates.

A “frequently asked questions” document that accompanied a final rule on ACA minimum plan benefits clarified that patients cannot be subject to a co-pay in the event polyps are discovered and removed during a routine colonoscopy. Colonoscopies are considered preventive services that qualified health plans must cover without additional patient cost sharing, but some affected insurers had been reclassifying the services in the event of polyp discovery, claiming it no longer was a preventive exam but a diagnostic procedure.

“This loophole meant patients could find themselves with an unexpected cost burden for a preventive service that was supposed to be free, because it carried an ‘A’ rating by the United States Preventive Services Task Force,” said Christopher Hansen, president of the American Cancer Society Cancer Action Network. He noted that the possibility of being exposed to even limited cost sharing can deter patients from getting the tests.

“The administration also offered guidance to close other preventive screening loopholes that led to unexpected cost sharing for individuals with a family history of cancer,” Hansen said. Those with a family history of breast cancer and at high risk of developing the disease should be able to get genetic counseling and testing at no additional cost, according to the FAQ document.

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