Reports from University of Michigan Describe Recent Advances in Affordable Care Act (Breast Health Services: Accuracy of Benefit Coverage Information…

Reports from University of Michigan Describe Recent Advances in Affordable Care Act (Breast Health Services: Accuracy of Benefit Coverage Information in the Individual Insurance Marketplace)

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- Investigators publish new report on Affordable Care Act. According to news originating from Ann Arbor, Michigan, by NewsRx correspondents, research stated, "The aim of this study was to determine if breast health coverage information provided by customer service representatives 'employed by insurers offering plans in the 2015 federal and state health insurance marketplaces is consistent with Patient Protection and Affordable Care Act (ACA) and state-specific legislation. One hundred fifty-eight unique customer service numbers were identified for insurers offering plans through the federal marketplace, augmented with four additional numbers representing the Connecticut state-run exchange."

Our news journalists obtained a quote from the research from the University of Michigan, "Using a standardized patient biography and the mystery-shopper technique, a single investigator posed as a purchaser and contacted each number, requesting information on breast health services coverage. Consistency of information provided by the representative with the ACA mandates (BRCA testing in high-risk women) or state-specific legislation (screening ultrasound in women with dense breasts) was determined. Insurer representatives gave BRCA test coverage information that was not consistent with the ACA mandate in 60.8% of cases, and 22.8% could not provide any information regarding coverage. Nearly half (48.1%) of insurer representatives gave coverage information about ultrasound screening for dense breasts that was not consistent with state-specific legislation, and 18.5% could not provide any information. Insurance customer service representatives in the federal and state marketplaces frequently provide inaccurate coverage information about breast health services that should be covered under the ACA and state-specific legislation."

According to the news editors, the research concluded: "Misinformation can inadvertently lead to the purchase of a plan that does not meet the needs of the insured."

For more information on this research see: Breast Health Services: Accuracy of Benefit Coverage Information in the Individual Insurance Marketplace. Journal of the American College of Radiology, 2017;14(4):482-487. Journal of the American College of Radiology can be contacted at: Elsevier Science Inc, 360 Park Ave South, New York, NY 10010-1710, USA. (Elsevier - www.elsevier.com; Journal of the American College of Radiology - www.journals.elsevier.com/journal-of-the-american-college-of-radiology/)

The news correspondents report that additional information may be obtained from R.C. Carlos, University of Michigan, Inst Hlth Policy & Innovat, Ann Arbor, MI 48109, United States. Additional authors for this research include G.E. Kolenic, J. Dozier, V.K. Dalton and R.C. Carlos (see also Affordable Care Act).

Keywords for this news article include: Ann Arbor, Michigan, United States, North and Central America, Affordable Care Act, University of Michigan.

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