Blogging the ACA

When I had my first colonoscopy there was no President Obama, no Patient Protection and Affordable Care Act, I hadn’t begun blogging, and I was on my employer’s health insurance plan.

The company I worked for would have liked nothing better than to present a cash payment to employees in lieu of paying their 65 percent share of health insurance. However, people they asked wouldn’t go for it.

My second procedure is scheduled Friday and I’m curious to see how it will be paid for by the health insurance plan purchased through the ACA marketplace for some $14,400 annually.

The ACA requires health insurance providers to cover recommended preventive services without any patient cost-sharing such as co-pays and deductibles. A colonoscopy is one of these services.

Information is seeping out through administrative cracks in the health care system. It began with a voicemail from the doctor’s office. My insurance company wouldn’t pay for the sodium sulfate, potassium sulfate and magnesium sulfate solution called a “bowel prep kit.” The kit came with two 6-ounce bottles of the solution and a handy plastic measuring cup. I asked our local pharmacist if I could buy it directly as I remembered it was inexpensive. With a $10 off manufacturer’s coupon it would have been $110, making it worth the trip to the clinic in the county seat to pick up a physician’s sample of the brew.

What I am finding in my limited personal health care is the ACA is peeling off add-on procedures that used to be covered by health insurance. No add-ons to physicals, colonoscopies, and other preventive procedures, at least in my experience.

I don’t know, but the change has to have affected gross margin for these businesses and reduced the cost of health care. Whether savings will be passed on in terms of premium reductions remains to be seen, but I doubt it.

While I didn’t receive a bill for my last physical examination, the hospital sent me a bill for lab tests, which I paid. We’ll see if there are any more cracks in the system after my procedure. If there are, I’ll be posting again.