I’m getting reports of a new dodge being used by insurance companies to avoid paying for the things the PPACA requires them to. The specific stories I’m hearing have to do with prostate-specific antigen tests. The PPACA requires that qualifying major medical plans cover annual screening PSA tests for men over 50 without insureds being required to pay additionally for them regardless of their deductible.
The dodge is that, if you ever get a moderate to high result from your PSA test, future PSA tests are considered diagnostic by your insurance company ever after rather than screening which means that you do need to pay for them out of pocket if you haven’t reached your deductible.
None of this affects the worthwhileness of the PSA test which has been called into question for the last decade or so. Many docs, including the guy who invented the test, now say that the test doesn’t tell you whether you have cancer, what type of cancer you have, or whether it will kill you. Basically, it just tells you that you have an enlarged prostate and a whopping 50% of men over 50 do.
Is anybody else hearing stories like this? Or just old guys like me?
Not having had an abnormal, couldn’t say. But the practice sounds duplicitous. The bigger issue seems to be the test’s usefulness. If you like your useless PSA we’ll mandate your useless PSA?
Medicare insurers are supposed to pay for colonoscopies — yearly if you’ve a family history or other indication, at 3 years intervals otherwise. The notion is they should pay all the costs, since finding colon cancer early is better than later. The actuality is that they pay all the costs UNLESS the colonoscopy finds polyps or anything else of interest, in which case the procedure is deemed “diagnostic” and they dump 20% of the cost or more on the Medicare enrollee. Finding polyps, I gather, is not that unusual an occurance.