Affordable Care Act should be free birth control and related consultations but my insurance doesn’t allow me to see gynecologist without referral from PCP which cost $15
I don’t know where to start because I am super confused by health insurance and how it works. I have LA Care Silver 87 HMO. I would like to get prescribed the pill as my form of birth control, and I read under the Affordable Care Act, that it should be covered by the plan, and at no cost to me (pills and related consultations). The issue is, I have a new PCP I have never seen before, and when I called them to schedule it as a preventative visit, they said it will count as a regular office visit and I will be charged Copay ($15). All I need to talk about is to get birth control, and nothing else. But they said I will need to schedule the doctor visit to be referred to the OBGYN. I checked with my plan, and it seems I cannot see any specialist OBGYN without prior authorization and referral.As per ~https://www.healthcare.gov/sbc-glossary/#screening~ , Preventive Care is defined as “ (Preventive Service) Routine health care, including ~screenings~, check-ups, and patient counseling, to prevent or discover illness, disease, or other health problems.”
All my EOB says about this is:If you visit a health care provider’s office or clinic:
-Primary care visit to treat an injury or illness – $15 copay/ visit
-Specialist visit – $25 copay / visit
-Preventive care/screening/ immunization – No charge
I asked my plan about this, and if the doctor visit should count as a preventative visit since I am not sick and there is nothing to diagnose/ treat in my case, and they said that the specialist visit (OBGYN appointment) will be of no charge to me, but I still do have to pay the copay when I visit the doctor’s office. I don’t understand why I have to pay the copay, when all I need is the birth control consultation which is free under ACA, but it is hidden behind a paywall that is the PCP visit ($15) in order for me to get the referral (because I can’t just go to the OBGYN without the referral). So actually, for me to get my hands on birth control, it is not “free”.
Is it because I am a new patient, so the PCP office needs to charge the new patient with CPT code 99202 (I think? I don't know, just googled new patient visit and if it is covered under preventative care, and for some reason it is not.) So assuming this, would my next year of getting birth control renewal actually be free (PCP visit to get the referral, and specialist visit)? I’m not sure what the PCP office should be billing since I am making an appointment JUST to get a referral. (Because again, I am not sick (I just want to be protected against pregnancy), so it should all be preventative, I think? Everything related, in theory, should be covered in order to get the birth control, but it’s not, and I am confused as to why it isn’t)
submitted by /u/momohuntsharon
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