Has the game changed?

[Protimenow]

With the new health care regulations that went into effect yesterday (9/23), 'preventive' testing must be paid for, without deductions, by the insurance carriers.

The examples they give are colonoscopy and mammograms. NEITHER of these are preventive -- they are diagnostic, and the theory is that if problems are detected very early, they can be treated and would prevent the spread of the tumor.

I haven't read the health reform act, so I don't know the answer -- but WOULDN'T INR MONITORING BE BOTH DIAGNOSTIC AND PREVENTIVE? The testing would, of course, tell what your INR is so that you can adjust your warfarin dosage to 'prevent' (actually, reduce the risk of) stroke or uncontrolled bleeding. Has anyone used this rationale to get the insurance companies to pay for meters and test strips - without requiring co-pay or deductibles?

I have no insurance, so I can't check....but it would be interesting to see what the Insurance Companies say about this - or, if anyone read the provisions covering 'preventive' testing, to see what you may think of this. (FWIW - I'll bet you can probably get a meter and a year or two of strips for what the insurance companies now have to pay for a mammogram or colonoscopy)

(You can probably use a similar argument for blood glucose monitoring - which is relatively much less expensive than anticoagulant testing - and can help prevent problems related to too much, or too little, blood sugar. )

Any thought on this?

 

[Cris N]

I did see this on the healthcare.gov website: http://www.healthcare.gov/law/provisions/preventive/index.html and http://www.healthcare.gov/law/about/provisions/services/lists.html

Love the disclaimers though... (too many ifs for my taste)

 

[Protimenow]

Thanks.

When I get a chance, I'll plod through the docs.

If someone has already done this, and has some idea where it applies; or if someone has actually asked their insurance providers, this could be quite interesting.

 

[Protimenow]

I took a look at HealthCare.gov that Cris N provided, and it warfarin therapy (and ongoing blood glucose monitoring, either) don't specifically show up.

Perhaps some time in the future, when (if) they expand the health care law, essential, ongoing testing like the one for INR, would have to be covered.