Under the Affordable Care Act (ACA), most health plans are required to cover certain preventive care benefits at no cost, but we have all heard stories about a coworker who was charged a copay for his annual physical, or a cousin who had to pay her deductible when she had her mammogram. Here’s a look at how to make sure you don’t have to pay unnecessarily when you go to the doctor’s office.
1. Choose an in-network provider
One of the most important things to remember about your preventive health benefits is that they are covered in full only when delivered by an in-network provider. That means you will be responsible for paying the charges billed if the provider is considered out-of-network.
2. Schedule your visit as preventive care
If you want to avoid a copay at your next annual physical, make sure your appointment is scheduled (and billed) as “preventive care.”
3. Come prepared
Print out or bookmark a listing of preventive services covered under your plan. Take the list with you to your appointment. Make sure the lab and/or physician knows these are the services you expect to receive.
4. Don’t discuss preexisting conditions or other illnesses
During your visit, don’t talk about seasonal allergies, discuss an aching knee or ask for advice on how to sleep better. The minute you open the discussion to anything other than preventive care, the visit becomes a diagnostic exam and you may be charged.
Keep in mind that your plan covers only a specific list of preventive services at no cost to you. If you try to discuss anything with your doctor that is not considered preventive, they may charge you for the visit. There is a fine line between preventive and diagnostic, and you want to be sure not to cross it.
For a complete list of preventive health services, visit the ACA website. You will find detailed information about what services are available for adults, women and children.
For information about health insurance options please contact our benefits advisors. They can be reached at 800-637-4676 or [email protected]. Or you may request information online.
Source: Applied Systems, Inc.
