State Health Plan Policy Regarding Mobile Screening Services
August 1, 2005
RALEIGH – The State Health Plan has become aware that the company Ultrascreen is offering to provide "preventive medical screening" services to State Employees [and Teachers] which are eligible for reimbursement under the NCFlex Health Care Spending Account. Although the fine print of the memo indicates that "insurance and Medicare will not pay", we wanted to be sure that you were aware of the State Health Plan's position on such mobile screening services.
Of the tests provided as part of these mobile screening services, only the Total Cholesterol, HDL, LDL, Triglycerides, Cardiovascular risk ratio, and Glucose (diabetes) test are eligible for coverage under the State Health Plan. A claim form will need to be submitted by the member to the Claims Processing Contractor for this service to be covered as the Ultrascreen company does not submit claims on behalf of members. However, the Plan recommends that patients see their personal physicians for such testing rather than using these mobile services see rationale below).
All of the other tests provided, including carotid artery for risk of stroke, thyroid gland scan, abdominal aorta for aneurysm including liver, kidneys, pancreas, spleen, and gallbladder, Doppler test of peripheral arteries, ultrasound testing for bone density (osteoporosis), and ALT liver test for liver abnormalities, will not be covered by the State Health Plan.
The rationale for this policy is the following:
RALEIGH – The State Health Plan has become aware that the company Ultrascreen is offering to provide "preventive medical screening" services to State Employees [and Teachers] which are eligible for reimbursement under the NCFlex Health Care Spending Account. Although the fine print of the memo indicates that "insurance and Medicare will not pay", we wanted to be sure that you were aware of the State Health Plan's position on such mobile screening services.
Of the tests provided as part of these mobile screening services, only the Total Cholesterol, HDL, LDL, Triglycerides, Cardiovascular risk ratio, and Glucose (diabetes) test are eligible for coverage under the State Health Plan. A claim form will need to be submitted by the member to the Claims Processing Contractor for this service to be covered as the Ultrascreen company does not submit claims on behalf of members. However, the Plan recommends that patients see their personal physicians for such testing rather than using these mobile services see rationale below).
All of the other tests provided, including carotid artery for risk of stroke, thyroid gland scan, abdominal aorta for aneurysm including liver, kidneys, pancreas, spleen, and gallbladder, Doppler test of peripheral arteries, ultrasound testing for bone density (osteoporosis), and ALT liver test for liver abnormalities, will not be covered by the State Health Plan.
The rationale for this policy is the following:
- The US Preventive Health Services Task Force, which was convened by the Public Health Service to rigorously evaluate clinical research in order to assess the merits of preventive measures, including screening tests, counseling, immunizations, and preventive medications, generally recommends against population screening for the above diseases, based on insufficient information that the results of such tests improve health for the individuals tested. Information on the recommended screening tests by this organization is available at www.ahrq.gov/clinic/uspstf/uspstopics.htm
- When such testing is not performed by the member’s primary care physician, appropriate pre-test counseling and post-test follow-up cannot be assured.
