ACR ‘concerned’ some commercial insurers are requiring cost-sharing for USPSTF-endorsed services
The American College of Radiology is expressing concern that some commercial insurers are requiring patient cost-sharing for preventive services that should be free.
ACR said it has received recent alerts from lung cancer screening programs that insurers are charging out-of-pocket fees for these lifesaving CT exams. The issue arose after a Texas district court judge declared an Affordable Care Act provision—requiring payers to cover preventative care services with no patient cost-sharing—unconstitutional in March.
“The American College of Radiology is concerned that some commercial payers are requiring patient co-payments for United States Preventive Services Task Force-endorsed preventive services,” ACR said in a Thursday, June 1, news update. “The [Texas judge’s] ruling has been appealed and it is not in effect; the college previously reported that it will continue to monitor this court ruling.”
The administration filed an official appeal of the ruling on April 12, and on May 15, the Fifth Circuit Court issued a stay on the lower court ruling as the case is reviewed. Currently, law requires insurers to provide no-cost coverage for screening services endorsed by the USPSTF, among other such entities.
March’s ruling applied to all task force recommendations issued on or after March 23, 2010, which was the day President Obama signed the ACA into law, the college reported at the time. This would include the task force’s December 2013 endorsement of regular lung cancer screening, with CT-based imaging of the colon likely also impacted.
ACR leaders are asking radiology providers to contact the college if they experience any prior authorization or patient cost-sharing roadblocks related to screening for lung, breast and colon cancer. They also shared a sample statement to send to insurers that have hindered payment for these services.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.