Health Care Reform = Free Preventive Care? Not Exactly

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Nobody likes being poked, prodded, or stuck with needles. But as I scheduled a physical last month, there was one thing that made me feel better about the whole thing. Even though I have a $5,000 deductible on my health insurance plan, for the first time in decades, I wouldn’t be getting a bill.

That’s because since September of last year, if you have health insurance, preventive care is free with no deductible or co-pay. From this July 10, 2010, press release posted at healthcare.gov…

For new health policies beginning on or after September 23, 2010, preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, co-insurance or deductible for these services when they are delivered by a network provider.

This is is one of health care reform’s chief benefits. I wrote about it last year in a post called Health Care Reform: 8 Positive Changes

Positive change number six: Free preventive health care.
Until health care reform, preventive care coverage… like annual physicals, for example… could be subject to deductible and co-pays. The new law says this type of care is going to be free: no co-pay, no out of pocket. The idea is that this will encourage people to seek assistance early and often, which should translate into big health problems and big bills being nipped in the bud.

You call this free?

I got my “free” physical last month. But a few days ago, the bills started coming in: $600 worth of “laboratory services,” $70 for “radiology services,” and $60 for “diagnostic services.” Since this was obviously an error, I called my insurance company. What did they say? That much of what constituted my preventive care wasn’t covered by the new law.

Of the seven laboratory services (translation: blood and urine tests) performed on me, only three were theoretically covered: the urinalysis, cholesterol screening, and PSA screening. I use the word “theoretically” because even those tests weren’t free. I was charged for them because, according to my insurance company, my doctor’s office failed to properly code them when they were submitted.

I guess chest X-rays must not provide enough “strong scientific evidence of their health benefits” to pass muster either, because that radiology service also wasn’t covered, nor was the EKG I was given. As my insurance company pointed out, they don’t fall into the category of routine preventive services as defined by the U.S. Preventive Services Task Force, the government agency that decides exactly what preventive care insurance companies should be paying for. Also not covered was the cost of drawing blood: Although the blood tests noted above are covered, according to my insurance company, you’re on your own when it comes to extracting the blood you want tested.

Net result? The only cost my insurance company paid for my annual physical was $80 for the office visit.

It’s not as bad as it sounds

While a lot of the expense of my physical wasn’t covered, much of it was radically reduced by virtue of the discount I receive through my insurance provider. For example, while the lab work totaled $612, after the discount, it came to only $57.25. And I can go back to my doctor and ask them to recode and resubmit the covered tests, which would reduce the bill further. I also got a significant discount on the chest X-ray, reducing the price from $70 to $26.64, and my EKG went from $60 to $20. So the cost of my physical, while not free, was still negligible. Disappointing, but still money well spent.

I just wish someone had told me that my “free” physical wouldn’t actually be free. Then maybe I could have discussed my options with my doctor, been prepared to see the bill and most important, I could have avoided a half-hour on the phone demanding an explanation from various representatives of my insurer. (A company I’m already not overly fond of: see Insurance Outrage: Hike Prices, Pay CEO $100,000,000)

Here’s a healthy idea

If you’re like me and have a high-deductible health plan, or are otherwise responsible for a lot of your health care costs, be aware that “free” preventive care isn’t necessarily free. Before you schedule your next preventive visit to your doctor, visit this page of healthcare.gov and see what the law actually covers: It’s different for different ages and sexes.

Forewarned is forearmed. But free or not, don’t skimp on preventive care. Unless you’ve got an extra one lying around, taking good care of the body you have is the most frugal thing you can do.

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  • Michael Johnson

    As a family physician, let me give you my 2 cents worth (I’ve already given up 70% to the insurance company).
    Preventive and continuity of care are cornerstones of family medicine.  We cherish them.
    What we don’t cherish are insurance companies.  That “discount” you received may benefit you, but it is a write-off for us.  Let me give you an example…

    My daughter saw a dermatologist and was charged $73 for the office visit.  Not bad.  I received the EOB (explanation of benefits) and saw that the “allowable” charge (per the insurance company) for the visit was $58.  My copay to see a specialist was $40.  So let’s do the math.

    Office visit – $73
    Allowable charge – $53           the dermatologist has to write off $20
    ———————————-
    Remaining  balance – $53
    My copay – $40
    ———————————-
    Remaining  balance paid by the insurance company to the physician – $13!

    So I pay $100 every 2 weeks for insurance so that I can pay 3 times what the insurance company pays for the visit!
    And the physician writes off more than he is reimbursed by the insurance company.

    This is from the patient’s perspective.  I can’t begin to describe the headaches we endure just trying to get paid.
    Remember, that charge you see from your physician is a fair market charge for services.  Commercial insurances “allow” anywhere from 50-75% of those charges.  Medicaid and Medicare “allow” ~35%.  We have to write off the rest.  I don’t see insurance companies crying about these bad economic times!

  • Anonymous

    Similar to you, I did and thought the same thing when I went for my physical, but my lab bill was $1000 (after being reduced) and both my EKG and follow up Stress EKG were $800…according to the insurance company, had I had the lab done before the new health care reform act it would have been covered 100%, but the EKG’s are not preventative even though I have family history on both sides of the family.

  • Anonymous

    I thought the same as you when I went to the doctor recently, but my lab came back as $1000 (after being reduced) and my EKG and follow up Stress EKG were $800 (after being reduced), evidently they aren’t preventative even though heart disease runs on both sides of the family…fun fact is that the insurance said if I had gone before the HCRAct, the lab would have been covered 100% as preventative, go figure…I am completely frustrated and the doctor wants me to do it all again, but I can’t afford it.