Does Blue Cross Blue Shield (BCBS) of South Carolina (SC) cover routine screening labs and preventative services?

Blue Cross Blue Shield of South Carolina Coverage for Routine Screening Labs and Preventative Services

Blue Cross Blue Shield (BCBS) of South Carolina does cover routine screening labs and preventative services, particularly those that have received an A or B rating from the U.S. Preventive Services Task Force (USPSTF), with no patient cost-sharing required under the Affordable Care Act (ACA) provisions.

Coverage Framework for Preventative Services

The Affordable Care Act (ACA) established provisions requiring health insurance plans, including BCBS of South Carolina, to cover 16 adult preventive services without any patient cost-sharing (no copay or deductible requirement) for individuals with health insurance plans beginning on or after September 23,2010 1. This coverage requirement specifically includes:

• Cancer screenings (breast, colorectal, and cervical)
• Annual wellness visits
• Routine laboratory tests
• Preventative health counseling

Cancer Screening Coverage

BCBS of South Carolina covers the following cancer screening procedures:

1. Breast Cancer Screening:

   • Annual screening mammography for women over 40
   • No cost-sharing required

2. Cervical Cancer Screening:

   • Pap testing and pelvic examination at three-year intervals
   • Yearly screening for high-risk women or those with abnormal results in the preceding three years

3. Colorectal Cancer Screening:

   • For individuals over 50 years
   • Options include colonoscopy, flexible sigmoidoscopy, and fecal occult blood testing
   • No cost-sharing required for initial screening tests

4. Prostate Cancer Screening:

   • Annual digital rectal examination and PSA test for men over 50 years 1

Important Caveats and Potential Out-of-Pocket Costs

Despite the ACA's provisions for preventative services coverage, patients may encounter unanticipated cost-sharing in certain scenarios:

1. Diagnostic vs. Screening Procedures:

   • If a screening colonoscopy results in polypectomy, some insurers may reclassify it as "diagnostic" rather than screening
   • A colonoscopy performed following a positive stool blood test may be considered diagnostic
   • Higher-risk individuals requiring more frequent screenings may have these classified as "surveillance" rather than preventative 1

2. Coding and Billing Issues:

   • How procedures are coded can affect whether they're covered as preventative services
   • State regulators have reported that unexpected cost-sharing for screening examinations is a common source of complaints related to ACA implementation 1

Access to Preventative Services

Having health insurance coverage significantly impacts screening rates. Research shows that:

• Screening rates among individuals without health care coverage are approximately half the rate of those with coverage 1
• Having health insurance, a regular doctor, and a regular source of usual care are all associated with higher cancer screening rates 1
• A recommendation from a healthcare professional is among the strongest factors influencing recent screening 1

Maximizing Preventative Service Benefits

To maximize benefits from BCBS of South Carolina's preventative service coverage:

1. Schedule regular wellness visits - These provide opportunities for counseling, screening, and case finding
2. Establish a relationship with a primary care provider - Having a regular doctor increases likelihood of receiving preventative service recommendations
3. Understand coverage details - Be aware of which services are covered without cost-sharing
4. Ask about screening recommendations - When patients don't receive screenings, common reasons include "did not think they needed it" or "doctor did not order it" 1

Conclusion

While BCBS of South Carolina does cover routine screening labs and preventative services without cost-sharing as required by the ACA, patients should be aware of potential reclassification of services from "preventative" to "diagnostic" which may result in unexpected costs. Regular wellness visits and establishing care with a primary care provider are key to accessing these covered preventative services.