Tags: Healthcare Reform | Obamacare | healthcare | physicals | co-pays

Angry Patients Find Obamacare's Annual Checkups May Not Be Free

By Drew MacKenzie   |   Monday, 14 Apr 2014 07:40 AM

Obamacare patients who go to their doctors for a free annual checkup are finding out that they may have to pay for the preventive healthcare visit after all.

They are angry to learn that if they mention past or ongoing health concerns during the physical, that can result in co-pays and deductibles, according to The Wall Street Journal.

Under the Affordable Care Act, preventive care includes screenings for high blood pressure and high cholesterol counts, evaluations for several cancers and diabetes, and vaccinations. The patient is allowed, in most cases, one checkup per year.

But "wellness" care on potential new health issues is viewed as "evaluation and monitoring," and leads to patients having to fork out for the "free" annual physical.

"Patients are scheduling physicals because physicals are free," Randy Wexler, a family physician in Columbus, Ohio, told the Journal. "But they come in and say, 'I've been having headaches. My back has been bothering me, and I'm depressed.' That's not part of a physical. That will trigger a copay."

Wexler says they are not happy about the charges. "They'll say, 'I have diabetes and hypertension and heart disease and seeing you is preventing them from getting worse, so that should be fully covered,'" he said. "But under that theory, everything would be free with no copay."

Doctors told the Journal that seniors have started canceling their annual wellness visits under their Medicare plans when they learn that if they mention a current health issue during the checkup they will likely be charged a co-pay.

Some doctors are even warning patients in advance of the problem and ask them to schedule two visits, one for the "annual" and another for their current health issue, according to the Journal.

Some insurers allow doctors to bill for their preventative and "non-preventative" services during the same visit using a special code called "modifier 25." But that can also lead to co-pays and confusion.

Charles Cutler, an internist in Norristown, Pa., and chairman of the American College of Physicians' board of regents, told the Journal he often gets calls from distressed patients months after their physicals saying they have been billed for co-pays.

"It's happened so often that I try to determine in the first few minutes if the patient has come for a specific problem or for an 'annual check'," he told the Journal.

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