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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