5 steps to avoid surprise bills for preventive health care

Avoid surprises and stay healthy Tuesday, February 19, 2019

When a trip to the doctor for preventive care comes with a surprise bill, it's not a happy surprise. The Affordable Care Act (ACA) mandates health plans cover the cost of preventive care, at no extra cost. But you may still get a bill from your doctor after a preventive visit.

Confused? That's understandable. We talked to customer service representatives and reviewed customer feedback to find out common situations that lead to surprise bills.

Based on those examples, here are 5 things you can do to avoid paying more for preventive care:

  1. Find a doctor that's in your health plan's network. Your ID card includes the name of your plan's network. Use that network to search our Find a Doctor tool before you make an appointment.
  2. Tell your doctor you're only interested in free preventive services. Better yet, make that clear when you schedule your visit.
  3. Speak up. People are sometimes afraid to ask their doctor questions about the care they recommend or how much it costs. Don't hesitate to ask.
  4. Print this list of preventive services from HealthCare.gov and use it to make sure you don't miss anything at your appointment. Preventive services may only be covered 100 percent if they happen during your annual preventive checkup.
  5. Remember when we mentioned your plan's network earlier? That applies to the lab your doctor uses to process test results, too. Ask if the lab is in your health plan's network.

What preventive care is included with your plan?

Adults and children get certain preventive care covered 100 percent under the ACA. There's an additional list for women's health services. Examples of adult preventive care benefits include:

  • Blood pressure screening
  • Colon cancer screening, if you're 50-75 years old
  • Type 2 diabetes screening, if you're 40-70 years old and overweight or obese. If you have diabetes, blood and urine tests associated with diabetes are not considered preventive.
  • Immunizations
  • Sexually transmitted infection counseling and some testing based on gender, age, and risk factors.
  • Human immunodeficiency virus (HIV) screening

Extra preventive care benefits for women include but aren't limited to:

  • Anemia screening
  • Breastfeeding support and counseling for women who are pregnant or nursing
  • Birth control and contraceptive care

Examples of preventive care for children include:

  • Newborn metabolic screening
  • Behavioral assessments
  • Blood pressure screening
  • Height, weight, and body mass index (BMI) measurements
  • Immunizations
  • Hearing and vision screening

When does preventive care cost more?

Your doctor might recommend services that you might need but aren't on the preventive lists or they may perform these services without alerting you that you might pay more. 

Talking about other issues (such as an injury or about high-blood pressure management), may result in an additional charge for an office visit.

Common preventive services that may come with surprise costs include:

  • The covered preventive services if you don't have risk factors or if your doctor does them more often than recommended.
  • Blood tests called a "general health panel." This is a set of tests that includes your blood count and levels of calcium, potassium, thyroid stimulating hormone, bilirubin and others in your blood.
  • Vitamin D deficiency screening. Doctors may recommend a vitamin D supplement if it could benefit you, even without this test. Ask your doctor if the test is important.
  • Comprehensive adult eye exam (unless you have vision coverage). A simple vision screening is not typically billed separately from a preventive visit.

How can you avoid surprise costs before you get a bill?

  1. Make sure your doctor is in your health plan's network. Use the Find a Doctor tool or ask when you make an appointment. Make sure to give the name of your plan's specific network
  2. Be clear when you schedule a doctor visit. Let them know you're only interested in free preventive services.
  3. Don't be afraid to ask questions like do I really need this test?  What are the risks?  What if I don’t do anything? And, about how much does it cost?. Some preventive services may only be covered 100 percent if they happen during your annual preventive checkup. So print this list from Healthcare.gov and use it to make sure you don't miss anything.
  4. Make sure your doctor uses a lab that is in your health plan's network. Sometimes your doctor may send you or your tests to an out-of-network lab. You won't know unless you ask.