United States: Two new studies found that insurance companies are still saying “no” to claims for free check-ups and preventive care that Obamacare should cover. They are also more likely to deny claims from people who are Asian, Black, or Hispanic, and from those who don’t have a lot of money, according to researchers in a medical journal called JAMA Network Open.
“What we document is that their inequities at the starting line,” said study co-author Michal Horny, an assistant professor of the health policy and management at the University of Massachusetts Amherst, adding: The life motto we are entitled to is ‘Let’s avoid avoidable illnesses.’ It will help to spend less in the future if those diseases do not need treatment because they could have been avoided in the first place.
According to HealthDay, another AMJPM study showed that patients with private insurance received charges for preventive services they should not be charged. This happened in 40% of the visits that were recorded.
Since the passing of the Affordable Care Act in 2010, many insurance companies have had to provide necessary vaccines and other preventive services.
However, the new research finds that patients still need access to this care or are burdened with out-of-pocket costs.
Writing in a university news release, Horny said, “Preventive care offers a lot of bang for the buck for patients and healthcare systems and population health in general.” “That is why the Patient Protection and Affordable Care Act required the involvement of health insurers in the provision of recommended preventive services for their beneficiaries without any costs.”
He counted 2.5 million preventive care claims filed between 2017 and 2020 by 1.5 million of his patients for the JAMA study.
In addition, Claims experience also revealed ethnic differences, low income patient were 43 percent more likely to have all or part of their claims denied than high-income patients. Billing for denied claims also followed ethnic divide.
Patients earning below USD 30000 paid a median of USD 412 for a denied claim, indicating half of such amount was charged more and the other half less. That compared to a median charge of USD 354 for patients with household incomes between USD 50,000 and USD 74,000 and a USD 365 charge for patients earning USD 100,000 or more.
Among the patients who were denied claims in the researchers’ study, non-Hispanic whites were the least charged compared to every other ethnicity.
These particular findings suggest that the experiences of patients seeking free preventive care differ based on their demographics and also lead to inequities in accessing basic preventive care, said the researchers.
The second study uncovered similar gaps, and privately insured patients were charged for 40 percent of the preventive care visits that should have been free.
Both studies looked at the claims data for seven preventive services that are supposed to be fully covered: birth control and wellness visits and screenings for diabetes, depression, cholesterol, and cancers of the breast and colon.
In the second study, less educated patients were 9.4 percent more likely to face out-of-pocket costs than those with college degrees, and on the flip side, the patients earning under almost 50,000 USD had 10.7 percent lower odds of being charged than high-income patients.