By Islam El-Sakka
Patients often receive unexpected bills for annual checkups that should be free under the Affordable Care Act, prompting a health policy expert to outline key questions to ask before and after a preventive visit.
Why preventive visits generate bills
The ACA requires most health plans to cover recommended preventive services — such as cancer screenings, vaccinations, and smoking cessation counseling — without cost-sharing. However, many patients are still charged because visits are coded as regular office visits rather than preventive care, or because providers are out-of-network.
Research reveals widespread billing issues
An analysis of a Pennsylvania survey by Sujeong Park, an assistant professor of health policy and addiction studies at Penn State Harrisburg, and colleagues Erin Duffy and Max Crowley found that nearly one in four insured respondents reported paying for their most recent checkup. Park herself received a $78 bill for a Pap smear that should have been fully covered; the charge was later removed after her provider corrected a coding error.
Key questions to ask before your checkup
Before an appointment, patients should ask their insurer which preventive services are covered without cost-sharing and confirm that their provider is in-network. During the visit, they should verify that the clinician bills the appointment as a preventive visit.
What to do if a bill arrives
If a bill appears, compare it with the insurer's explanation of benefits. Contact the insurer to ask why the service was not covered as preventive care, then call the provider's office to request a coding review. Many billing errors can be resolved this way, eliminating the charge.
