Are the “FREE” Preventive Care Services Really Free? - Synergy Benefits
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Are the “FREE” Preventive Care Services Really Free?

Why is it that “Free” Preventive Care Services aren’t always “Free”?

I personally think that one of the best provisions in the ACA was preventive care covered at 100%. There are no co-pays, no deductibles. This was already in place for HDHP plans back in 2004, but at the time the ACA became law (2010) the enrollment in HDHP plans wasn’t as popular as it is today.  A proactive approach and an incentive to stay on top of your health is important for everyone.

However, the free routine preventive services seem to have a snag. Here is my story:  I went to my primary care physician for my annual routine preventive exam. At first, the girl behind the desk tried to collect a copay. I advised her my appointment was a preventive routine physical and I should not have to pay a co-pay. Then when I went back for my exam, the physician was nice, then the nurse took several vials of blood, did a quick EKG, checked my reflexes, and my height and weight. It wasn’t until a few weeks later, I received a bill for $67 for my “free” preventive exam. When I called the insurance company, they indicated the Vitamin D Deficiency test (one of those vials of blood) is not deemed preventive (Section 2713 of the Affordable Care Act). I called my physician’s office and complained – but ultimately had to pay the $67 lab service. By the way, I have never been vitamin D deficient – I’m not afraid of the sun.

What should employers do?

My story is not unique. I have talked to my fair share of employees who get “balance billed” for preventive services or who have been charged a copay for the office visit. I have made it a goal to educate them while reviewing their benefits programs. I also recommend publishing various helpful websites which give individuals access to what the ACA covers www.healthcare.gov.

United Healthcare has a fantastic tool at their website www.uhcpreventivecare.com.  It’s specific to the persons’ gender and age, and you can print off the list of charges to take to your physician appointment.  It is important to educate people that if they go for preventive care appointment to use that appointment for preventive care – that way it should be coded correctly.  If you start discussing other ailments, a diagnostic code can apply – which negates your “free” preventive exam.  Also, if you have a pre-existing condition (diabetes, HBP, High Cholesterol) those pre-existing condition visits won’t be “free”. The whole point of preventive care services is to prevent you from getting those types of conditions. They will be covered, just not at 100% (your plan provisions will apply).

If you want to take advantage of the free preventative services, make sure that you are having that conversation on the front end before services are rendered, and before you get that bill in the mail for that “free” service. It’s important that employers provide educational meetings, communication pieces and videos to their workforce.  Knowledge is power.

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