Tuesday, October 1, 2013

Patient Advocacy: Healthcare on your side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse
Healthcare Specialist, Patient Advocate, Certified Mediator

Affordable Care Act:

Free Preventive Care Services Children

This is part 3 of a 3-part introduction to the provisions of The Affordable Care Act, regarding covered preventive services. Preventive services, screenings, educational resources and counseling are covered benefits as of Jan 1, 201, at no cost to the patient. Except in the case of grandfathered policies, even if a patient's deductible or out of pocket liability has not been completely met, the insurance will be responsible for the payment in full of these charges to medical providers.

Please note that, if any of these services is given as part of an office office relating to another condition, the primary diagnosis listed by the physician on the billing claim form may affect your final cost. For example, if your child sees a physician for an ear infection, and a vaccine booster is given, this visit will likely not be free to you until your deductible has been met, as the primary reason for your visit is not to get the vaccination. The cost of the shot will however not be your responsibility. If your child is seen for a "well child" visit, you should have no liability. 

A. For all Children
  • Behavioral Assessments: will be performed at regular intervals. 
  • Blood Pressure: your pediatrician will take a reading at each visit, and offer education and counseling for those at risk.
  • Dyslipidemia: screening will be offered for children at higher risk of lipids disorder. 
  • Fluoride: treatment will be available to children whose water supply does not contain supplementation.
  • Height, Weight, BMI: these measurements will be part of any medical visit.
  • Hematocrit/Hemoglobin:  screening for this common nutritional iron deficiency will be available.
  • Immunizations: twelve immunizations and booster shots from infancy to age 18 will be covered
  1. DTP (Duphteria, Tetanus, Pertussis)
  2. Haemophilus Influenzae b
  3. Hepatitis A
  4. Hepatitis B
  5. HPV (Human Papillomavirus)
  6. Polivirus
  7. Flu shot
  8. MMR (Measles, Mumps, Rubella)
  9. Meningococcal
  10. Pneumococcal
  11. Rotavirus
  12. Varicella

  • Iron: supplementation will be given to those whose screening reveals anemia.
  • Lead: testing to determine lead levels is recommended for every child, and especially those at higher risk due to inhalation or swallowing of lead particles through old paint dust, toys, furniture finish and other sources.
  • Medical History: updated at each visit, it will document a child's development, conditions, family history, environment situation and more.
  • Obesity: early screening and education are keys to optimal weight health. The medical provider will also provide information on healthy eating habits, recommend physical activities and advise on a weight-loss regimen if necessary.
  • Oral health: an assessment of your child's oral health and education on proper oral hygiene will be provided.
  • Tuberculin: screening should be performed every few years, and especially in those at higher risk of tuberculosis.
  • Vision: the physician will check your child for possible vision loss, as well as conditions such as lazy eye (amblyopia) or crossed eyes (strabismus).
B. For Newborns and children up to 3
  • Autism: screening will be performed between the ages of 18 and 24 months.
  • Development: evaluating your child's language and other progress will help make sure there is no need for further specialized intervention.
  • Congenital Hypothyroidism: Growth and development can be negatively affected by this hormonal imbalance.
  • Gonorrhea: a mother carrying the disease puts her baby at risk of blindness, blood infection and runs the risk of early labor. Medicated drops will be given to all babies after birth as a preventive measure. 
  • Hearing: babies will be tested within their first 30 days. Hearing impairment or loss may lead to speech and language difficulties.
  • Phenylketonuria: known as PKU, this condition prevents babies from processing certain foods and may lead to mental retardation. Special formula must be given if this diagnosis is established after birth. 
  • Sickle Cell: this blood disease can be serious; an early diagnosis will ensure early treatment and long term monitoring.

C. For Adolescents
  • Alcohol and Drug Assessment be provided to all teens, especially those at risk.
  • Cervical Dysplasia: known as the PAP Smear, this routine screening should be a part of every sexually active female wellness strategy, ensuring the early diagnosis of abnormal cells which may lead to cancer. 
  • Depression: your teen should be evaluated as a wellness measure, and definitely if signs are present. Many treatment and counseling options are available.
  • HIV: regular testing should be performed, especially for those with high risk behavior. Educational and counseling resources will be made available. 
  • STD: Chlamydia, gonorrhea and syphilis are sexually transmitted diseases which may cause serious problems, and which may be transmitted to a newborn. Regular screening in those sexually active is a covered benefit.
While most if not all of these steps were already enacted by your pediatrician, the goal of the ACA lies in getting all children to see a physician at regular and recommended intervals, without fear of cost, inexistent or inadequate insurance coverage or lack of awareness.  Reaching out to parents to bring their children for well care visits is expected to save lives, money and resources, by providing education and counseling for those at risk and by the early diagnosis and treatment of conditions which may have become chronic and serious otherwise. For parents, knowing their child is healthy, monitored and  that they not need to be ill in order to see a physician should bring peace of mind, especially if they have little or no liability. 

©  [2016] Advimedpro.
©  [2016] Martine G. Brousse.
All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements

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