Civic Helpers Improves Access to Cancer Screenings Nationwide

At the heart of Civic Helpers’ philosophy is that even one person sharing their problem can have a big impact.

In that spirit, we are very excited to let you know about a recent piece of vital Civic Helpers work involving healthcare. This is one of our most significant accomplishments to date.

With the passage of the Affordable Care Act, recognition of barriers in healthcare—especially related to cancer —has increased. Insurance copays can keep people from accessing preventive medicine, including cancer screenings. The American Cancer Society’s Cancer Action Network fought to reduce these barriers in New York State. In 2015, they successfully convinced New York State to enact a law expanding copay coverage for breast cancer screenings. In 2018, prostate cancer screening was added to the copay coverage list with a similar law. Unfortunately, passing laws alone doesn’t always bring about needed change. Civic Helpers learned about an improperly charged copay for a cancer screening in New York, and we sprang into action.

Medical billing is done through billing codes, also called CPT codes. Healthcare providers use CPT codes that are sent to insurance companies, which determine copays and other charges. Some cancer screenings, however, have no specific CPT codes, so providers bill them some other way, such as an “office visit,” which makes it impractical for insurance companies to distinguish a legally-required copay-free visit from situations where they can (and do) bill a copay. Civic Helpers applied to the American Medical Association (the AMA), which oversees CPT codes, to update a CPT medical billing code covering preventive services that are not subject to insurance copays, deductibles, and other charges. The American Cancer Society provided helpful information to help us complete the very involved AMA application. Ultimately, our request to improve billing procedures for preventive services was approved. You can read more about it here and scroll down to “Tab 63”. This change extends well beyond New York State; ending copay and related charges removes a meaningful barrier to healthcare access and cancer screenings across the United States. Lives may be saved, though we’ll likely never know whose.

This is an example of what Civic Helpers does - take one person’s experience and use it to shine light on (and then solve) a much larger problem. If you want to support our efforts to continue this work, please make a donation now through our online portal.