Stop-smoking interventions are also supposed to be free. "But what does that mean?" Spangler asked. "Does it mean counseling? Nicotine replacement therapy? What about drugs (that can help smokers quit) like Wellbutrin or Chantix? That hasn't been clearly laid out."
But the greatest source of confusion is colonoscopies, a test for the nation's second leading cancer killer. Doctors use a thin, flexible tube to scan the colon and they can remove precancerous growths called polyps at the same time. The test gets credit for lowering colorectal cancer rates. It's one of several colon cancer screening methods highly recommended for adults ages 50 to 75.
But when a doctor screens and treats at the same time, the patient could get a surprise bill.
"It erodes a trust relationship the patients may have had with their doctors," said Dr. Joel Brill of the American Gastroenterological Association. "We get blamed. And it's not our fault,"
Cindy Holtzman, an insurance agent in Marietta, Ga., is telling clients to check with their insurance plans before a colonoscopy so they know what to expect.
"You could wake up with a $2,000 bill because they find that little bitty polyp," Holtzman said.
Doctors and prevention advocates are asking Congress to revise the law to waive patient costs — including Medicare copays, which can run up to $230 — for a screening colonoscopy where polyps are removed. The American Gastroenterological Association and the American Cancer Society are pushing Congress fix the problem because of the confusion it's causing for patients and doctors.
At least one state is taking action. After complaints piled up in Oregon, insurance regulators now are working with doctors and insurers to make sure patients aren't getting surprise charges when polyps are removed.
Florida's consumer services office also reports complaints about colonoscopies and other preventive care. California insurance broker Bonnie Milani said she's lost count of the complaints she's had about bills clients have received for preventive services.
"'Confusion' is not the word I'd apply to the medical offices producing the bills," Milani said. "The word that comes to mind for me ain't nearly so nice."
When it's working as intended, the new health law encourages more patients to get preventive care. Dr. Yul Ejnes, a Rhode Island physician, said he's personally told patients with high deductible plans about the benefit. They weren't planning to schedule a colonoscopy until they heard it would be free, Ejnes said.
If too many patients get surprise bills, however, that advantage could be lost, said Stephen Finan of the American Cancer Society Cancer Action Network. He said it will take federal or state legislation to fix the colonoscopy loophole.
Dunphy, the Phoenix businessman, recalled how he felt when he got his colonoscopy bill, like something "underhanded" was going on.
"It's the intent of the law is to cover this stuff," Dunphy said. "It really made me angry."
AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson
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