Have HDHP with deductible, question about meaning of IL statue about full body skin check.
HDHP, Illinois, asked insurance (Aetna) about annual skin check (scheduled, coming up next month) and received this reply:
Your coverage
The in-network benefit for CPT 99214 with any of the diagnosis codes L57.8, L82.1, D18.01, D36.7, L70.0, D23.72 and L73.8 is 90% after the $1500 plan year deductible. Your plan has an out-of-pocket maximum of $1500 each plan year. Once your out-of-pocket maximum is met, allowed charges for the remainder of the current plan year will be considered
at 100%. We show you have met $301.47 of the deductible and out-of-pocket at this time.
Your plan also includes out-of-network benefits. Please contact us if you need the out-of-network benefit information.
* A referral is not required from your PCP to visit an in-network doctor.
The information provided above is not a guarantee of coverage. Coverage is based on all the terms and conditions of your plan as well as eligibility at the time services are received.
But I also found this in Illinois statue:
https://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=021500050K356z.37
(215 ILCS 5/356z.37)
Sec. 356z.37. Whole body skin examination. An individual or group policy of accident and health insurance shall cover, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement upon the insured patient, one annual office visit, using appropriate routine evaluation and management Current Procedural Terminology codes or any successor codes, for a whole body skin examination for lesions suspicious for skin cancer. The whole body skin examination shall be indicated using an appropriate International Statistical Classification of Diseases and Related Health Problems code or any successor codes. The provisions of this Section do not apply to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to 26 U.S.C. 223.
(Source: P.A. 101-500, eff. 1-1-20; 102-558, eff. 8-20-21.)
So who is right and who do I believe? And should I cancel my skin check or ask my provider/billing how much would be for cash price (without going through insurance)?
Thank you
submitted by /u/miki_cat
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