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About those ‘free’ checkups …

By Jay MacDonald ·
Tuesday, March 25, 2014
Posted: 6 am ET

Karen Garloch found something she really didn't expect on her first "free" wellness visit with her doctor: a bill.

"It happened to me in 2012 when I saw my family doctor for an every-other-year checkup," she writes in The Charlotte Observer. "My insurance paid $256, the total for the preventive exam. But the 'explanation of benefits' showed that I also owed $74.60, my share of the $113 bill for an 'office visit' -- on the same day, in the same time slot."

What the heck? After all, beginning in 2011, the Affordable Care Act required health insurance companies to offer free annual wellness visits to some 54 million Americans with private health plans. Obamacare also provides a free annual checkup to 32.5 million seniors on Medicare.

1 office visit, but 2 billings

When Garloch inquired about the unexpected bill, she learned that her warm-fuzzy wellness visit should have come with a caveat.

"(My doctor) explained the second charge resulted from our talk about my elevated cholesterol level, which had been diagnosed previously. Because he documented that discussion and marked the billing code for evaluation and management of a cholesterol diagnosis, I was billed for the second visit," she writes. "I have learned since that it's not unusual to get this extra charge with a preventive exam."

Garloch says several factors may have helped generate that additional bill.

Just following the rules?

For example, some insurers have tightened up what constitutes a gratis wellness visit to more closely adhere to the Affordable Care Act. Physicians are under increased pressure to document each service they provide, partly because of new Medicare reimbursement criteria. And the growing number of high-deductible health plans may prompt patients to save up their health questions for their free annual exam to avoid paying extra for separate visits.

"Because this is confusing to patients, some doctors have begun sending notices in advance, letting patients know they could be charged extra if they bring up questions that aren't considered part of a preventive exam," she says.

Consider yourself warned.

Do you think it's fair that you could be billed for a "free" exam?

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April 01, 2014 at 1:55 am

When they tried that business of billing for part of a physical with me. I put up quite a stink. Told them I'd drag the payments out if appeal was unsuccessful and would fire my doctor because of coding error. Took almost 9 months but insurance paid for all, without me appealing. Don't put up with paying for what is supposed to be free. They're ripping you off! Raise heck with them! Two bills for the same time slot is "double dipping" , don't stand for it! This industry needs a financial reality check, just like the rest of us have been getting for years! Having less customers is no excuse for ripping the ones you still have, off!

Rob Larson
March 28, 2014 at 6:40 am

As a Doc I can tell you that Medicare wasn't offered as the universal single payer because the premium was in the 10's of thousand dollars and God knows Washington politics didn't want the public to once again see that Big Government is unable to run anything on the background of politics. It's not to say a single payer system could not work because I believe it could. Health care operating in a capitalistic model, that is for profit, just seems wrong.

Max Keene
March 28, 2014 at 1:00 am

It seems to indicate that the best solution would be expand Medicare to cover every one and slowly move to 'Single Payer' universal health care. We could always wait till the cost of health care helps bankrupt our already fragile monetary system. Or just let catastrophic medical cost continue to bankrupt many individuals as happens now,take a look at the lien records in your local court house.