In April I wrote about how Obamacare’s preventive care mandate was under attack at the Supreme Court. In that post I mentioned how the preventive care annual wellness visit is not particularly valuable care and there are numerous ways to turn free preventive care into a costly diagnostic visit.
Annual Wellness visits are a minefield of surprise medical bills. It is especially bad when patients receive preventive care from a hospital or university-owed medical clinic. Everything done during your free wellness visit is not free; only preventive care is. Any care that follows up on a previous problem is not considered preventive care. Sometimes a few words can change a free preventive care visit into a costly, diagnostic one. If you say you have gastrointestinal problems, stomach aches, blood in your stool, for example, your free preventive colonoscopy will be billed as diagnostic rather than preventative. You pay for those under regular cost sharing. Doctors do not always remember (nor care) that you specifically scheduled a free annual wellness visit. They provide the care they believe you need or the care their employers require them to.
Kaiser Family Foundation (KFF) Health News explains the problem in detail in its Bill of the Month column, saying the patient expected a free checkup. The bill was $1,430. The following is what KFF Health News had to say:
Carmen Aiken of Chicago made an appointment for an annual physical exam in July 2023, planning to get checked out and complete some blood work.
The appointment was at a family medicine practice run by University of Illinois Health. Aiken said the doctor recommended they undergo a Pap smear, which they hadn’t had in more than a year, and testing for sexually transmitted infections.
They’d tested positive for HPV in 2019 and eventually cleared the virus but had not received the vaccine to prevent future infections.
They also needed some lab work done, part of routine monitoring for one prescription.
Services at Aiken’s appointment included a pelvic exam, a vaccination, and blood work, checking, in part, glucose levels and liver function.
Arguably, Ms. Aiken’s first mistake was mixing the free preventive services with diagnostic care in the same office visit. Any discussion of a disease or condition is likely to change the billing code from wellness to treatment. The former is free once a year, while diagnosis or care requires cost-sharing. Doctors up-code the free wellness exam to a higher-level exam because the scope for annual wellness exam is limited and the reimbursement is exceptionally low. Indeed, the bill for Ms. Aiken’s clinical service charges included no wellness exam. Rather, there was a charge for a 40-minute exam with high medical decision making at a list price of $786 before insurance discounts. Of the $1,181 (list price) of charges for vaccines and immunization administration (that is giving the shot), Ms. Aiken owed $206.91 after insurance coverage and negotiated discounts. Owing nearly $207 would be thoroughly irritating when you expected your cost to be $0.00, but it gets worse. There was also bloodwork and a pathology report for checking up on a previous HVP infection. Her bill listed the pathology report and lab services under Hospital Services. Ka-ching! Add another $2,858 before insurance adjustments. After health plan discounts, Ms. Aiken owed an additional $1,223 for (non-preventive) Hospital Services. While the pathology report was about $100 dollars after discounts, the bloodwork was around $1,131. That is approximately $1,000 more than I pay for the same service for using Walk-in Lab or DirectLabs.
It is bad enough to discover that free care was not free. It is even worse when care is billed through a hospital when cheaper care is available. Your specimen does not even have to touch the hospital to be hospital-based. Of the $1,430 Ms. Aiken owed for her free wellness exam, perhaps $1,200 of that was because it was performed in an expensive hospital facility. Medical bills are never fun. They are even less fun when you discover you overpaid for them. It should not have to be this hard.
Read more at KFF Health News: The Patient Expected a Free Checkup. The Bill Was $1,430.