Featured in US NEWS | By Kimberly Leonard


Unexpected questions can change a free wellness visit into an expensive diagnostic one.

Patricia Jones thought she was getting the much-talked-about free physical under Obamacare when she went to see a doctor in May. But, she says, a few small things that happened during her checkup ended up making the visit cost more than $450.

First, the doctor asked Jones, who lives in Oregon and describes herself as a full-time mom, if she had moles that were changing colors. When Jones pointed to a spot on her neck, the doctor said it was not even a mole and nothing to worry about.

Then her doctor asked her if she wanted to have a second child, and Jones replied that having one made her tired enough. The doctor said she probably should have a blood test to figure out the cause of her fatigue.

The doctor also asked whether Jones had any current health problems. She mentioned that she hurt her foot a couple of years ago and that it occasionally bothered her. The doctor looked at her foot, touched it, and took note of it in her medical record.

Later, the bill for the “free” check-up came, leaving her confused and leading to rounds of phone calls with her doctor’s office and insurance company. U.S. News confirmed the charges.

Jones, who declined to share her real name because her family’s medical records have been hacked in the past, now knows that these questions, along with her answers and possibly other things that happened during what she thought would be her preventive visit, caused it to be billed as a diagnostic one – something her insurance company didn’t cover in full as it would for a typical physical.

Stories like this are common among patients, who struggle with confusion about what prevention services insurance covers under President Barack Obama’s health care law, the Affordable Care Act. The Obama administration has widely touted the free preventive benefits as a major perk of the law, encouraging Americans to take advantage of them.

“The idea was for patients to no longer avoid getting preventive screenings or checkups because they couldn’t pay for them,” says Trisha Torrey, founder of the Alliance of Professional Health Advocates. “These kinds of things always have unintended consequences.”

Under the law, most health insurance plans must cover a set of preventive services without any cost to patients. Services include vaccines, colonoscopies, mammograms, pap smears, diabetes screenings and tobacco use screenings – all aimed at helping doctors and patients catch problems early, so they don’t become costly and more difficult to manage later.

Patients are soon discovering, however, that anything else discussed during a visit with their health care providers could cost them.

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