Insurance Benefit: Can AARP Help?

[BarryR668237]

Beginning in 2025 my state (Connecticut) has a new law that requires medical insurance companies to cover the cost of cardiac calcium scans. Unsurprisingly, no one involved with my upcoming scan--cardiologist, insurance company, or radiology center--knows anything about this law.

It's a state law, and AARP touts its legislative advocacy branch--how would I get them involved to try to attack what appears to be willful ignorance of this law? Thanks.

[TRL1111]

I'm not sure you need advocacy.  Can't you just give the providers and/or your insurance company a citation to the new law?  Maybe even print a copy of it for them?

[BarryR668237]

That’s exactly what I did. Responses from everyone in the chain: mostly crickets. 

Radiology center (after putting me on hold to speak with a supervisor): “We’ve never heard of this. You know you sign a waiver saying you won’t request reimbursement for this, right?”

Insurance company: to their partial credit, after saying they hadn’t heard this, either, after I gave them the procedure code they told me that the procedure is 90% covered in-network or 50% out-of-network with a pre-approval. Better than nothing, but it’s not like this law was passed New Year’s Eve at 11:59 PM. They’ve had months to learn about this—presumably someone’s job is to pay attention to new state laws. 

Cardiologist: literally the first thing he said to me when I asked about getting this test was “You know it’s self-insured, right?” In retrospect, I interpret that as “Please don’t ask us for a pre-approval, we have enough to do.”

I’ve also considered reaching out to my state legislators, as the law (unsurprisingly) is written in fairly vague terms.

it will all be moot—I’m just going to pay the $100 out-of-pocket and move on—but it’s likely I’ll have this scan again someday and it would be nice if everyone involved knew what the real story is. 

[TRL1111]

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@BarryR668237 wrote:

it will all be moot—I’m just going to pay the $100 out-of-pocket and move on—

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Wow.  I sure as hell wouldn't.  But I always want things to be done "right."  It makes me mad when something I buy is gets rung up cheaper than what's on the price tag--it's to my benefit but equally (or more) important to me is that it's wrong.