Insurance Blog

Finance Blogs » Insurance Blog » About those ‘free’ checkups …

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?

Follow me on Twitter: @omnisaurus.

Get more news, money-saving tips and expert advice by signing up for a free Bankrate newsletter.

Bankrate wants to hear from you and encourages comments. We ask that you stay on topic, respect other people's opinions, and avoid profanity, offensive statements, and illegal content. Please keep in mind that we reserve the right to (but are not obligated to) edit or delete your comments. Please avoid posting private or confidential information, and also keep in mind that anything you post may be disclosed, published, transmitted or reused.

By submitting a post, you agree to be bound by Bankrate's terms of use. Please refer to Bankrate's privacy policy for more information regarding Bankrate's privacy practices.
lorraine smth
March 27, 2014 at 5:19 pm

'after spending close to 12 years in school and being able to diagnose and treat various diseases, I think they are justified in complaining about payments. After all, the ones who set up these rules are LAWYERS and you can bet they are NOT limiting their OWN earning power.

After all, if you are dying, are you going to call a lawyer or a doctor????

March 27, 2014 at 5:13 pm

I truly feel that the best doctor to chose is by "word of mouth".
Do your homework and choose wisely. We all need someone that is
caring and has our best interest at heart and not the "money thing." Also, beware of any doctor that wants you to have a
"standing appointment." Those doctors only use people to have a
steady income.

March 27, 2014 at 4:32 pm

It REALLY must be a bit(h to spend all that money & time to become a medical profession & find that you must chest & scam the sick & vulnerable to make a buck.. I do feel soooooo sorry. The biggest decissions I imagine is which diagnois makes my wallet feel the best.

March 27, 2014 at 4:29 pm

Who thought that government takeover of our healthcare system was going to lead to higher quality and cheaper healthcare? You would have to be from another planet not to have anticipated what is now, only the tip of the iceberg. I don't blame the doctors, most of whom will be seeking other employment, soon. And we are all going to suffer. It's an unmitigated disaster!!

March 27, 2014 at 4:20 pm

Anyone notice that not any doctor or medical student that blogged on here made any mention of only wanting to help/heal
people? They did nothing but complain.

March 27, 2014 at 3:33 pm

It's nice to find out how those in the medical field really feel.
Sounds like it's all about money, money, money.

James Taylor
March 27, 2014 at 3:15 pm

@ Vicky
I will remember that next time i see you getting in your BMW to drive home to that over sized 4 bedroom house of yours in the burbs while i get on the city bus on my way home to my studio apartment as i will have plenty of time to contemplate my wonderful "American" healthcare visit that's supposed to be a 1 time free visit. In this nation's weak pathetic economy be thankful you have a job and customers.

March 27, 2014 at 3:08 pm

@ELANA: Please do not practise in NJ if and/or when you get your
license. You are too angry - NJ residents would never accept you and put you in your place immediately.

March 27, 2014 at 3:05 pm

It's too bad that 4 years of med school actually translates into learning how to diagnose and prescribe the "right" expensive drug - not nutrition, not actual wellness. I don't blame people for trying to cram as much as they can into one visit - it takes 2 months just to get an appt unless you're at death's door!!

March 27, 2014 at 3:03 pm

Wouldn't socialized medicine solve it. I've to many Canadian friends and they are happy with their system.