How asking a question can turn into an unexpected doctor’s bill

Reporter: Lauren Sweeney Writer: Jack Lowenstein
Published: Updated:
Credit: via WINK News.

Insurance companies cover preventative care as an incentive for you to stay on top of your health; however, there is fine print for these so-called free exams and procedures with health care providers.

A viewer from Fort Myers contacted WINK News’ Cost of Care after getting an unexpected $240 bill at what was supposed to be her well care visit, covered by Medicare.

“I said, ‘It was my first well care with Medicare, and I thought it was all taken care of?'” said Linda Baltes. “And (Lee Health) went on to say, ‘Due to some conversations I had with somebody, parts of that were not covered.’”

Jon Hess with Athos Health said he sees people fall into preventative care traps all the time.

“Ask your doctor questions, but just realize if they start doing a physical examination, if they start asking you more history questions; ‘How did you hurt your shoulder etc.?’ Now, you start slipping into a sick visit, a diagnostic visit,” Hess explained.

In his opinion, you will have to pay for that diagnostic exam regardless of the reason you head to the doctor, so you should not be wary of asking questions about something that is bothering you.

He said when consumers make assumptions about what is considered preventative care, it can result in bills a lot larger than Baltes.

For procedures such as mammograms and colonoscopies, there are specific rules such as age and medical history that dictate whether or not the insurance company will cover these as preventative without any out of pocket cost to the consumer. If you don’t fall into those rules, you could be looking at thousands out of pocket for such a procedure.

“There’s actually an entire national task force devoted to determining the rules for what is preventive and what’s diagnostic,” Hess said. “Most places use the U.S task force or preventive care, which lists what things should be covered, and it changes every year.”

Lee Health wouldn’t talk to us about Susan Baltes’ situation, but she said she was refunded her money after she told them she was speaking with WINK News. She claimed they blamed it on a coding error, but she is skeptical if that’s what really happened.

“I learned going forward, I’m asking, ‘Is this covered? ‘Is this covered? ‘Is this covered?’ before I go in,” Baltes said.

Hess said asking those questions upfront is the best way to avoid a big unexpected bill for preventative care.

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