06/29/2011
Preventive care benefits update
 We recently updated our preventive care flyer to more clearly identify that only the listed services will be paid at 100% for members impacted by health care reform laws. Any services not on the list of guidelines are subject to regular plan benefits.
We also want to make you aware of some further updates regarding preventive care services:
Mammograms
- Preventive mammograms meeting the U.S. Preventive Services Task Force (USPSTF) guidelines will be paid at 100% when provided at a facility or a physician's office. Claims billed at a facility were originally paid incorrectly. Any impacted claims have been reprocessed.
Colonoscopies
- There has been some confusion regarding what's covered as a preventive care benefit. Routine colonoscopies are paid at 100% if they meet the USPSTF screening guidelines. Any procedure performed due to a medical condition and any subsequent diagnostic colonoscopies aren't considered routine preventive screenings and will be covered as a regular medical benefit.
- When a polyp is found during a screening, we'll pay for the procedure (if it's covered under health care reform law), but the provider needs to bill certain codes. When the polyp is sent for a pathology test, the test is normally considered diagnostic, so standard lab benefits apply. If the lab bills the test with a preventive diagnosis code, it will be paid at 100%. In the majority of cases, labs won't know if the procedure is preventive or diagnostic.
- Based on our analysis of the USPSTF guidelines, we'll now cover at 100% screenings billed with certain family history codes for members under age 50.
- We're providing training to ensure that physicians and labs apply the appropriate coding for both the colonoscopy and any associated lab tests. Members with questions on how their claim was processed can contact Customer Service.
Tobacco Cessation benefits
- Health care reform now requires that we include "first dollar" preventive benefits for tobacco use counseling and interventions. We've determined that this will include treatment and pharmacotherapy benefits. We now cover prescriptions for generic tobacco cessation medications at 100% and are updating our claims systems. If a member is required to pay up front, they can send in the claim for reimbursement.
For groups of 100+
- We're now giving large groups the option of expanding the benefits that will be paid at 100% when billed with certain preventive diagnosis codes. This option gives a group not only the preventive services limited by age and frequency as indicated in the USPSTF guidelines, but broader preventive care services as well.
Members can call the phone number on the back of their ID card for further information. If you have questions, please contact your Regence Sales representative.
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