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Free preventive care? Not exactly

Under the health care law, annual 'preventive care' is supposed to be free. I got a bill for $730.

By Stacy Johnson Oct 20, 2011 1:56PM

This post comes from Stacy Johnson at partner site Money Talks News.


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 (and your plan hasn't been grandfathered in) 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 so far. I wrote about it last year in a post called "Health care reform: 8 positive changes."

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, 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 have 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 the cost of extracting the blood.


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's office 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. Post continues after video.

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.

 

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.


More on Money Talks News and MSN Money:

18Comments
Oct 20, 2011 5:20PM
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My colonoscopy, "The best way to prevent colon cancer" according to the letter I received from my doctor cost me over $1700. Apparently if they ever find polyps the procedure becomes diagnostic. This could happen while you're unconscious.

You have to dig to find this info on your insurance providers website. It's hidden under multiple layers and sends you in circles.

Oct 20, 2011 6:27PM
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And the HIGHEST PAID CEO in the Country is at McKesson (Pharma Co), makes a 131 million annually... WTF Only idiots don't know why Healthcare is so expensive... It''s the Insurance companies and Big Pharm driving it all, courtesy of our BOUGHT and PAID US Congressional

W h o r e s !!!!  By the way one of the Top ten CEO's is United Health Care, also in the 100 million range. 

Oct 20, 2011 6:15PM
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As psycho Nancy so eloquently told us, you have to pass it before we know what is in it! Now we know what it's allabout, and it ain't pretty...
Oct 20, 2011 6:12PM
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And this $730.00 bill suprises you why? You didn't actually believe the hype last year did you?
Oct 20, 2011 6:36PM
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If Obama really wanted to change something for the good of  the insured he should have mandated all insurance copmpanies be non profit.

No, if Obama REALLY wanted to lower the costs of health care, he would have told his trial lawyer lobby to stuff themselves and ordered tort reform! Author's doctor was ordering a plethora of addl tests to cover all the bases. i.e. save his own @$$.
Oct 20, 2011 6:30PM
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I gave up on annual physicals about 7-8 years ago.   My strategy for good male health now is to frequently check my body for anything unusual.  You know, unusual bumps, lumps , bruises, cuts that won't heal, rapid weight gain or loss and anything out of the ordinary.  Take a good multivitamin once a day, make love frequently, kiss and hug the one you love and eat right.  Chocolate is good, dark grapes, tomatoes, fresh fruit, whole grains and a limited amount of dairy products.  Read the labels for the type of  fats and amount of sodium you put into your body and put any product back on the shelf that has more than 3 chemicals listed.  And for heavens sakes; LISTEN to the side affects of the drugs you think you might need.  There is a reason WHY they list them on TV ad's. 

I recently went to visit my 9 year old grand daughter and was going to take her for a fast food burger.  Her response was - grandpa I don't eat junk food.  Like father like son I guess, LOL.  Oh, and if your doctor doesn't ask you why you think you might need that drug - find a different Doctor.

Oct 20, 2011 6:29PM
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outrageous balances aside, I have noticed that I was able to take my daughter to the pediatrician for her well-child visits for almost a full year before this whole "no copay" thing was put into place. I would pay my $25 copay and I never received a bill from the pediatrician, only if we had to go to a specialist. Then this no copay thing was enacted, and suddenly insurance will cover everything EXCEPT $25. So now instead of just paying it at the office, I have to wait for the pediatrician to send me a bill, then I have to send a check. I guess I should count myself lucky that I'm not getting all this crazy charges, but it's still massively annoying. I would rather just keep the copay and not have to mess with it 2 months later.
Oct 20, 2011 6:37PM
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wait until socialized healthcare gets firmly entrenched...you think you're paying a lot now, just imagine the what the future holds...even less care at higher prices with more beuracracy.

Oct 20, 2011 6:30PM
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The problem is that insurance companies dictate policy based on how much profit they can benefit by. Not based on you, or your health needs.  I believe all insurance companies should be non-profit organizations.

If Obama really wanted to change something for the good of  the insured he should have mandated all insurance copmpanies be non profit.

Oct 20, 2011 6:53PM
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Realize that preventive care is based on age, health history and family history. If any of these have red flags they must be addressed. Preventive care for a 25 year old is much different than a 50 year old. I'm assuming this patient is older and required tests that would not be ordered for a younger patient (CXR, EKG, PSA).

This is where the dreaded "defensive medicine" dilemma occurs. If these tests are not done, based on indications to do them, then if anything happens to the patient (heart attack, lung tumor/COPD, prostate cancer) the attorney's have a field day.

Remember, you don't perform medicine, you practice medicine. Every single patient that walks into a doctors office is unique, with seperate and special circumstances. Evaluating, diagnosing and treating is different in each and every person.

Oct 20, 2011 6:40PM
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How's that "change" working out for ya!
Oct 20, 2011 6:18PM
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My wife just experienced the same problems. Made an appointment for a well care check. The physician ordered PTH lab work which changed the exam from preventive care. We received a bill for $835.00.
Oct 21, 2011 9:49AM
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This points out one of the main problems with our health care/insurance system. Why if the insurance is involved it only costs $57 otherwise it cost over $600 for the lab work? If you ask the Dr. how much it will cost he can't tell you. If the insurance is willing to pay $550 for the service why can't the work be done for that amount instead making the patient pay the rest?
Oct 20, 2011 6:49PM
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Hello! McFly! Come get this free cell phone.  Wow! I was astounded that there were additional costs!?  How about cable for $50 a month, What the price goes up after a few months!?  Shocking! People try to get money from you!  Wake up and smell the napalm in the morning jack holes.  "I fool and his money are easily parted"
Nov 7, 2011 12:54AM
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Are you kidding?  Somebody should have told you that there's no such thing as a free lunch?  You're the money columnist...
Oct 21, 2011 4:59PM
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The high cost of healthcare is directly related to the insurance companies and Pharma.  Don't blame the Doctors, Hospitals, Nurses or Labs.  They get paid pennies on the dollar and have to jump thru numerous hoops just to get that.  I receive 2 or 3 advertisements every day from insurance companies like United Healthcare, Aetna, BCBS, and Humana.  They are inviting me to restaurants for a "free lunch" to hear them talk about their "wonderful" Medicare Advantage HMO  Plans.  For every person they can sign up, they get up to $300 bonus from Medicare.  Advertising and marketing cost a lot of money, especially on television.  Just notice how many ads you see sponsored by insurance, drug and medical supply companies..  Insurance companies do not provide ANY healthcare, yet they suck up a majority of the healthcare dollars and everyone blames Doctors and Hospitals.  The other problem with healthcare is the uninsured who go to Emergency rooms where hospitals and doctors are mandated by law to provide care.  Do away with insurance companies, ambulance chasing attorneys, and government mandates and see the cost of healthcare drop like a lead balloon. 
Oct 21, 2011 2:00PM
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We are going to find out what free means. Somebody has to pay and it should be the ones receiving the benefits!!
Oct 20, 2011 6:31PM
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The author seriously thought an EKG would be a covered preventative service?  Lucky he didn't ask for an MRI to be performed along with the boat load of other "hey its my annual physical, so it must all be free!!" services.  Its like going to a wedding reception: just because you got in the doors for free and get a salad and chicken doesn't mean its an open bar!

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