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News & Thought Leadership

Why Do You Keep Getting Billed For Preventive Services?

The Affordable Care Act must provide insured and self-funded plans preventive services with no cost sharing.  But people are still being billed for these services. Why is that?

There is much confusion between the US Preventive Care Guidelines and providers about what is covered versus what is not. The guidelines do not include the Common Procedural Terminology (CPT Codes) to clearly state what services are preventative. Providers have been only coding one way which leaves some services in a gray area. To fix this problem, many employers have developed different policies to simplify the process and make it more transparent to those insured. Employers have also asked health plans to share resource guides with providers defining what services are covered. With these guidelines, services can be coded and member service can be improved with more transparency.

 To determine how to simplify this process and get a better understanding feel free to reach out to us here at Cambridge.



Arthur Grutt,
212-695-7463 | Managing Partner


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Arthur Grutt