"It frustrates me that I've gone through the work of learning about [no cost-sharing for PrEP-related services], and there's a lot of people who don't know about it and are just paying these copays," Sacco said. "The cost burden for me is not as bad, but it could be more for others."Maria Tildon, a marketing and lobbying executive at CareFirst, would not comment on Sacco's case.
"We're in the throes of developing and distributing a pretty aggressive communications campaign to our provider partners to make sure that as they offer this treatment, they know how to submit the claim," Tildon said. Samuel Le Church, a primary care physician and certified medical coder in Georgia, said it is "probably accurate" that many doctors prescribing PrEP aren't coding the other services as preventive, but "to be fair, there are so many things that come up with insurers ... and there's only so much bandwidth physicians have."After Axios asked CareFirst about Sacco's case, and as Sacco filed an appeal with the D.C.
Tildon added CareFirst is conducting a retrospective review to see if other members who take PrEP have paid for related services and are owed refunds: "We want our members to be billed appropriately." This is part of Axios' series, Billed and Confused. Have you been hit with an unexpected medical bill? Maybe the overall medical billing experience left you feeling puzzled or upset? Email
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