Coverage of Colonoscopies Under the Affordable Care Act's Prevention Benefit

Interviews were conducted with state health insurance regulators, state consumer assistance program directors, medical directors of major insurance companies, medical experts, insurance billing experts, and patients to gather qualitative research using a convenience sample. Those interviewed included medical directors of seven major insurers in four states—California, Connecticut, New Mexico, and Washington, as well as billing staff of two medical group practices in New Mexico and South Carolina. Interviews were also conducted with department of insurance staff, including regulators and consumer assistance program personnel, in six states – Connecticut, Georgia, Maine, North Carolina, Oregon, South Carolina – as well as the Connecticut Office of the Healthcare Advocate. All interviews were conducted between March and June 2012. Stories of patient experiences were collected by staff of the American Cancer Society and the American Cancer Society’s National Colorectal Cancer Roundtable. Information included in the report from the interviews was compiled and re-verified by interviewees to ensure an accurate reflection of interview discussion. Patient names were changed for inclusion in this report.
Report Conclusion