Shirley Zerkel to Sandra Knoesel: Questions about preventive services in basic policy

From Shirley Zerkel, November 14, 2006

Dear Ms. Knoesel:

The brief information in the fall sign up for insurance states: "For 2007, 100% coverage of designated preventive services ( no deductible or coinsurance) has been added to the Basic Plan...." What designated services? We are not told! Then I go to the STRS 2007 Health Care Program Booklet that a retiree has to call and ask for: "Enrollee pays no money out of pocket - no deductible or coinsurance- for designated in-network services (deductible and coinsurance will apply for out-of-pocket services. (page 12)." Then page 22 states in a chart under preventive services the following: Physical Exam, Colorectal Cancer Screening, PSA, Pap Smear and Mammogram. Most retirees do not have this book!

I went to your website and guess what I know there? A more complete list! How many retirees bother to look that far for information that should be given to them up front? This is the list from the website: Evaluation and Management Physicans Visit, Cancer screening (colon, prostate, pap, annual gyn exan, clinical breast exam,) endoscopy procedures, Radiology (Mammagram, osteoporosis, barium enema screen), Lab ( PSA, Fecal Occult Blood, complete blood count, Metabolic panel, thyroid studies, cholesterol-lipid panel, Hep and surface Antigen, HIV, Urinalysis), EKG, TB skin test, Immunizations ( Influenza B, Polio, Tetanus, Diphtheria, Rotavirus, Rubella, Hep A & B, Herpes Zoster-shingles, Varicella, Pneumococial, influenza, FluMist, Meningococcal).

Doctors must use wellness diagnosis code or a procedure code solely designed for preventative services. You can't indicate any symptoms at this physical exam less the doctor takes actions and bills it accordingly. You the patient can't indicate any systems-less the doctor takes action or bills accordingly.

I called my provider and they did not even have all of this information so when Jan. 1, 2007 arrives, I know there will be some incorrect billing for services. Why isn't information that we, the retirees, need to know given to us in entirety so that we can really make the right choice for ourselves? We are given only part of the information and then all entities (STRS, the retirees and the insurance company) involved do not have the same information.

Thank you,

Shirlee Zerkel