5 steps to avoid surprise bills for preventive health care

Avoid surprises and stay healthy Tuesday, November 01, 2016

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, women, and children each get certain preventive care covered 100 percent under the ACA. Adult preventive care benefits include:

  • Blood pressure screening
  • Colon cancer screening, if you're over age 50
  • Type 2 diabetes screening, if you have high blood pressure
  • Immunizations
  • Screenings for certain sexually transmitted infections (STIs)

Extra preventive care benefits for women include:

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

Children's preventive care benefits include:

  • Behavioral assessments
  • Blood pressure screening
  • Height, weight, and body mass index (BMI) measurements
  • Immunizations
  • Vision screening

When does preventive care cost more?

Your doctor may recommend services that will cost you more money. Or they may perform these services at your preventive visit, without informing you that you'll pay more.

Talking about other issues (such as an injury), 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, and bilirubin in your blood.
  • Vitamin D test. Doctors may recommend a vitamin D supplement if it could benefit you, even without this test. So you may want to consider this route.
  • Skin exam or skin cancer screening. Your doctor may recommend this if you're considered high risk or if you have certain warning signs. But it will still cost extra.
  • Adult eye exam (unless you have vision coverage).

Have you received a surprise bill from a preventive checkup? Do you have advice to help others avoid surprise costs? Share your experience on our Facebook page.