preventive care


Lesson Of The $446 Ear Rinse: Medical Bills That Make You Say ‘What?!’

(Photo: Robin Lubbock/WBUR)

(Photo: Robin Lubbock/WBUR)


Get your attention, all those upper-case, bold-face letters? They certainly got mine, when they came in the mail recently. It was a virginity-losing moment: My first debt-collection letter in more than a half century of financial clean living.

And of course, it was a medical bill that did it — just as it’s medical care that causes more American personal bankruptcies than any other bills.

My health bills for preventive care had all seemed reasonable until now — or at least, they were bountifully paid by insurance. Mammograms, children’s check-ups, all were fully covered. But I’d shifted recently to an insurance plan with a $500 personal deductible, and I’d made a naive mistake: When my doctor kindly offered to clean my waxy ears during my annual check-up last April, I said, “Okay…”

Well, really, how was I to suspect that three or four minutes of whooshing ear-rinse could add up to $446 out of my pocket? (Correction: $446 upon first billing, but knocked down to $338.03 after several long and tortured phone calls, and a medical re-coding. It still struck me as insane, but I paid it to get the collection agency off my back.)

Doctor, if we’re going to cross the line from preventive to billable, I’d like you to let me know.

It’s an ever-more-common American rite of passage: That shocking moment when you unfold the bill, look at the total that is unpaid by your health insurance, and expostulate, “Are you (expletive) kidding me?!?”

Readers, do you have an eye-popping bill and back-story you’d like to share? We’re hoping to make this a series — “Medical Bills That Make You Go ‘What??!'” You can send in your story — and, if you’d like, scans of your bills that will protect your privacy — by clicking on the “Get In Touch” button at the bottom of this page. Goodness knows, you have few other outlets for your frustration.

In my own case, I’m asking you to brave the numbing tedium of any billing tale because there’s a clear object lesson here: Yes, preventive care, including check-ups, must be fully covered by insurance plans under Obamacare. But that doesn’t mean that everything that’s done during a check-up has to be covered.

And therein lies the rub. The line between “preventive” and “diagnostic” or “procedural” can creep up on you, as WBUR’s Martha Bebinger has reported: When Is Preventive Care Free And When Do You Pay? Her report included this valuable lesson: As one Massachusetts woman was horrified to discover, it’s possible to go in for a free — because it’s preventive — colonoscopy, but then, while you’re still on the table, if the doctor finds polyps and removes them, that transforms it into a non-preventive — and thus potentially billable to you — “surgical procedure.”

I’d read that story but clearly I didn’t take its lesson enough to heart. I also take full blame for my longtime practice of getting routine primary care at an expensive top Boston hospital: You can see in the upper right corner of the image above that the initial charge to my insurer for my check-up — which involved no lab tests and nothing higher-tech than a blood pressure cuff — was nearly $1,192.

Still, in hopes that my own financial pain might help others, I asked Blue Cross/Blue Shield of Massachusetts, the biggest health insurer in the state and the one that happens to cover me, for useful pointers. I spoke with Debra Wilson, a senior manager in the Member Service Division. Our conversation, lightly edited:

DW: I think it’s great that you’re highlighting this for people. Folks go in and have preventative visits, and things will invariably come up. The patient is there and having their physical, but they’re also addressing problems. These problems could be longstanding. So it’s important that when something does come up and present itself, that the patient ask questions.

It’s very important that all of us are educated in our health care decisions, and part of that is that we not be afraid to ask, ‘What does that entail and what might the cost be?’

Ask questions beforehand so you’re fully aware of what’s going to be involved, not only with the procedure but the cost. It can generate a liability to the patient, and no one likes an unplanned bill. We’ve also asked our network management team, the folks in the field working with physicians’ offices, if they could also educate the patient at the time — usually after the fact, but let them know, if they were in for a visit and also had a procedure or additional service, that they could receive a balance bill.

We don’t want to discourage these conversations with physicians because it’s probably something they do need to have addressed, and it’s being done all in one trip, so it’s efficient. We just want everyone to be aware of what could happen in terms of cost liability, that that could change depending on services rendered.

The tricky part for the patient is that it can be hard to know whether something is considered preventative or diagnostic or a procedure. For example, at that same checkup of mine, my doctor found that my blood pressure was a bit elevated, so we discussed ways to lower it. Conceivably, that could be billed as not preventive but diagnostic, or an education procedure?

That’s discretionary, based on that particular provider’s office and their billing practices. Certainly, that could be within the preventative visit, but again, I think it’s important not to be afraid to ask those questions.

Would it be reasonable to go into a preventive appointment and say, ‘Doctor, if we’re going to cross the line from preventive to billable, I’d like you to let me know’? Would that be weird? Continue reading

She’s Gotta Have It: 8 ‘No-Cost’ Women’s Health Services Now Available

Alan O’Rourke/flickr

Liz Pugh, 23, is a recent college graduate with a job at a nonprofit AIDS advocacy group and financial independence for the first time in her life. Every month she shells out $15 or so of her modest salary for a co-pay on her birth control pills. But no more. The next time she runs out to the pharmacy to resupply, there will be no additional cost. “I am relieved,” she said. “to see that $15 co-pay gone.”

On August 1, insurers for the first time in history were required to start providing women with a set of basic preventive health services — not just birth control — for no extra fee. Though contraception and some of the other newly covered services, such as breast feeding support and equipment, have received most of the media and political attention, the new coverage spans a range of screening, counseling and other health services for women of all ages.

The new provisions fall under the federal Affordable Care Act and, according to Dr. Paula Johnson, Chief of the Division of Women’s Health at Brigham and Women’s Hospital in Boston, “represent a paradigm shift from a health care system built on diagnostic treatment of disease toward a foundation of disease prevention and wellness promotion.”

Johnson is a member of the Institute of Medicine Committee on Women’s Health Preventive Services — the group that recommended the new services be covered — and Executive Director of the Connors Center for Women’s Health and Gender Biology at the Brigham. She says that “cost has been a significant barrier for women” in accessing these basic medical services, and the new requirements “will allow women to get the preventive care that they need without the financial worry.” Moreover Johnson says, having these eight new services covered by insurers “raises the bar for preventive care for women,” and will ultimately strengthen the bond between doctors and patients.

Here, Johnson summarizes the 8 services women with private health insurance will now have access to without cost-sharing, and why these tests and services are vital for overall health:

1. Well-woman visits: Half of women delay or avoid well-woman preventive services due to cost barriers. Continue reading

I'll Have What She's Having: ‘No-Cost’ Women’s Health Services Start Today

By Dr. Paula Johnson
Guest Contributor

August 1, 2012 marks the first time in history that insurers will be required to provide women with a set of core women’s health preventive services without cost-sharing. These services are part of the Affordable Care Act’s (ACA) robust plan of preventive care for women across the lifespan and represent a paradigm shift from a health care system built on diagnostic treatment of disease toward a foundation of disease prevention and wellness promotion.

Dr. Paula Johnson, Chief of the DIvision of Women’s Health, Brigham and Women’s Hospital

Unfortunately, not all U.S. women will benefit from the new system of care. With June’s Supreme Court ruling, some states may refuse to expand Medicaid to millions of our country’s poorest women, many of whom are near elderly, depriving them of access to preventive services available to Medicaid recipients and a better chance at a healthy life.

Let’s be clear that the preventive health services available under the ACA will allow women to become healthier and help reduce cost. Prior to reform, more than half of U.S. women were not up-to-date on recommended preventive health services, a fact not surprising given the growing epidemic of chronic illness among women that is costly, at an estimated $466 billion per year, yet preventable.

The new preventive services available to women with private insurance include:

Well-woman visits: Half of women delay or avoid well-woman preventive services due to cost barriers. Continue reading

The Colonoscopy Switcheroo: Quirks Of ‘Free’ Preventive Care

Arelis Gomes points out the free preventive care information in her Health Care for All brochure.

Don’t miss today’s incisive report by WBUR’s Martha Bebinger on when free preventive care is not free preventive care. That is, the federal health overhaul aimed to make much preventive care free, from check-ups to screening tests, but that’s not always how it plays out in practice. And sometimes you only find out when you get the bill or are asked for the co-pay.

The Web version is here and the full script is below, but I just wanted to highlight the part that really blows my mind: As one Massachusetts woman was horrified to discover, it’s possible to go in for a free — because it’s preventive — colonoscopy, but then while you’re still on the table, if the doctor finds polyps and removes them, that transforms it into a non-preventive — and thus billable to you — “surgical procedure.” Not to pick nits, but doesn’t polyp removal prevent colon cancer?

WBUR's Martha Bebinger

We have a story you might want to file under Consumer Beware. The new federal health care law makes dozens of preventive tests free for patients. Doctors or hospitals are not supposed to charge patients anything for an annual check-up, most screening tests and a dozen other services such as tobacco. This provision of the law began taking effect, as you renewed your coverage, more than a year ago. But as WBUR’s Martha Bebinger reports…there is still confusion about how it works.

Arelis Gomes, an outreach coordinator for the consumer group, Health Care for All, spends her days deciphering and explaining the federal Affordable Care Act or ACA. For more than a year now, she’s been telling consumers that they will no longer have to pay anything for preventive care. So Gomes says she couldn’t believe it when she arrived a few weeks ago for her annual check-up and the receptionist asked Gomes for her co-pay. Continue reading

Your One-Stop Shop For No-Co-Pay Care

WBUR's Martha Bebinger

More from WBUR’s Martha Bebinger (Yes, it’s a Martha morning!): On our new Healthcare Savvy site, where users can share and compare their health costs, she reminds us here that under national health reform, a lot of preventive care is now supposed to be free. That is, free of co-pays.

But like everything in health reform, it’s complicated, practices vary and there are exceptions. So she’s done the legwork of getting the lists from the three major Massachusetts health insurers of their preventive services that should now be free of co-pays. See her post here.