Consumer Hit with Surprise and Illegal Bills for Preventive Care

By Consumers For Quality Care, on February 1, 2022

Last year, the federal government reminded health insurers that consumers who take pre-exposure prophylaxis (PrEP), a medication that prevents HIV, should not be paying anything out of pocket for the drug. However, consumers still found themselves receiving bills, according to Axios.

Individuals who take PrEP should have no copays, fees, or other out-of-pocket costs. This includes any blood work or doctor visits associated with the medication.

Last year, Peter Sacco of Washington, D.C., was charged $130 for two doctors’ visits and the associated lab work.

“It frustrates me that I’ve gone through the work of learning about [no cost-sharing for PrEP-related services], and there’s a lot of people who don’t know about it and are just paying these copays. The cost burden for me is not as bad, but it could be more for others,” said Sacco.

Under the Affordable Care Act, many preventive treatments are required to be covered by health insurers. While some bills were due to doctors not coding PrEP-related visits as “preventive,” it is ultimately up to the insurer to ensure there is no cost-sharing for these visits.

Ultimately, Sacco’s insurer refunded all his copays, and they are conducting a retrospective review to see if other members who take PrEP have paid for related services and are owed refunds.

Insurers must continually ensure consumers are not receiving – and paying – unnecessary bills. Consumers should also be aware of their patients’ rights when it comes to preventive measures.