The Affordable Care Act (ACA) requires health plans that came to market after the law was signed in March 2010 to include preventive care services as first dollar coverage (i.e., no copayments). The Academy is concerned that this could mean loss of revenue for pediatricians.

As part of its private payer advocacy, the Academy contacted the largest national carriers, including Aetna, CIGNA, Humana, HealthNet, UnitedHealthcare and WellPoint, to assess their policies concerning coverage for preventive care services and waiving copayments. Most have indicated that physicians should not see a decrease in revenue due to a copayment being waived. For example, if the fee schedule for a preventive care service is $50, which includes a $10 copayment, the $40 balance has been paid by the carrier. If the copayment is waived under the new rules, the carrier will pay the entire $50.

While most of the carriers’ health plans are expected...

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