Thursday, December 18, 2014

Does healthcare law limit number of medical tests you can receive?


Question: I am a breast cancer survivor of almost four years. I have heard through other cancer patients that the new law will limit the number of CAT or PET scans to one per year even though the oncologist would like to do 2 per year. Is this true?

- Ruth

Answer: The law does not limit the number of medical tests you can receive. That decision is up to your physician and your insurance company. Each plan contains its own coverage rules concerning tests your physician recommends. While the law requires that those rules provide full coverage for basic preventive tests, CAT scans and PET scans for cancer survivors are not among them. You can find coverage details for each plan in the Summary of Benefits and Coverage that the insurance company provides.

Medicare has considered placing limits on the number of CAT and PET scans that it will cover for cancer survivors. The limits you have heard about may be these. However, Medicare rules determine coverage only for that program’s beneficiaries, not for those covered through private policies issued under the Affordable Care Act.

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    Robert I. Field, Ph.D., J.D., M.P.H. is a professor of law at the Earle Mack School of Law and professor of health management and policy at the School of Public Health at Drexel University. He also writes for The Field Clinic blog. Ask Rob your questions about the new healthcare law.

    Robert I. Field, Ph.D., J.D., M.P.H. Professor, Earle Mack School of Law & Drexel School of Public Health
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