Progressive employers have been offering “preventive” care for “free” to their employees for a long time. Under the new national healthcare law, “preventive care” will also be included for free. Unfortunately, I put “preventive care” in quotes because it has hundreds of different definitions, and they vary wildly by plan and employer. The definition for national health care reform has not even been developed.
Here are some examples of the problems patients face: 1) they go in for a mammogram, which they are told is free, but it is not if they have been diagnosed with breast cancer; 2) they go for a check up with their doctor, which they are told is free, but the doctor does other things and they get charged with an office visit; 3) they go for a colonoscopy, which is free, but during the exam, the doctor removes polyps and they wake up with a bill for hundreds or even thousands of dollars; 4) they take birth control pills to “prevent” pregnancy, but that is not considered pregnancy; and 5) they take anti-cholesterol drugs to “prevent” heart attack and stroke, but they get billed that they are “treatment” for high cholesterol.
These issues cost patients thousands of dollars, stress and unhappiness. Doctors get less than half as much money under most plans for “preventive” visits as for “office visits” so they tend to bill the office visit unless you specifically tell them you ONLY want preventive care. Even then, the doctor makes notes in your file, a nurse interprets those, and then a professional coder translates it into a billing form for the two dozen or more plans that doctor participates in. The doctor might me in Medicaid (called AHCCCS in Arizona), Medicare, KidsCare, Schip, VA, workers’ compensation, United Healthcare, Cigna, Blue Cross, Aetna, Healthnet, PPOs, HMOs, HSAs, and on and on. Getting your bill right for your plan is very difficult.
The following is a two page guide developed by United Healthcare and the Valley Schools Employee Benefits Trust (VSEBT) a local purchasing cooperative for their members ran by Tom Boone and Andrea Billings. The advice might not apply to everyone, but it can give you better ideas for how to handle this important issue when talking to your doctor. Thanks to them for letting me reprint this advice here. It is in Adobe format. You can download the reader for free if you don’t already have it.
If you have any difficulty reading this, please feel free to comment on this page with your email, and I will send you a copy.