“The ACA did not classify pediatric dental services a preventative care service”

I’ve been fighting with my health insurance (United Healthcare) over their refusal to cover my child’s 6 month dental cleaning because I haven’t paid the deductible yet.

It was my understanding that the ACA requires preventive services to be no cost especially for children.

This is their response. Is this true? Has anyone here heard of this distinction before?

Preventative services under ACA Section 2713 of the ACA mandates that non-grandfathered health plans cover certain preventative services without any cost-sharing (i.e., no copays, coinsurance, or deductibles) when provided by network providers.

Pediatric dental services: However, pediatric dental services are treated differently. The ACA did not classify pediatric dental services a preventative care service. Instead, they are considered an Essential Health Benefit (EHB) for individuals and small groups. This means that while these services must be included in health plans, they are not necessarily exempt from cost-sharing requirements like other preventative services.

UnitedHealthcare’s policy: UnitedHealthcare (UHC) follows this distinction. Their policies indicate that pediatric dental services may be subject to the plan’s deductible and other cost-sharing mechanisms. This in in compliance with the ACA, as the law allows for cost-sharing on EHB’s, including pediatric dental services.

In summary, while preventative medial services must be covered without cost sharing, pediatric dental services fall under a different category and can be subject to deductibles and other cost sharing requirements.

submitted by /u/goodlittlesquid
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