The Unintended Consequence of Free Preventative Care

Be careful when hoping for "free" preventative care. From the Charlotte Observer:

I have learned since that it’s not unusual to get this extra charge with a preventive exam.

In the past year or so, primary care doctors say they have struggled over how to manage their time during preventive visits when patients bring up questions about chronic medical problems. If the discussion in a preventive exam turns to previously diagnosed conditions, the code for that signals the insurance company to pay for an “office visit,” which usually means a co-pay from the patient.

“It’s very confusing, even for the doctors,” said Dr. Dino Kanelos of Carolina Family Healthcare in Ballantyne. “I just finished (a preventive exam) with a lady who had 15 medical problems she wanted to discuss.”

There are multiple factors at work here. This practice of billing for an extra visit began before the Affordable Care Act’s insurance mandate took effect Jan. 1. But some doctors and insurance companies may be using this opportunity to more strictly follow guidelines about what qualifies as a preventive service under the act, and must be covered 100 percent without patient cost-sharing.

In addition, doctors are under pressure to document everything appropriately in the electronic medical record or they could be subject to Medicare reimbursement cuts in the future. That takes more time, so they have less time to handle extra questions from patients. And with the growing prevalence of high-deductible insurance policies, patients may save their questions for the preventive exam, hoping they can avoid paying the full cost of a separate medical visit.

“It’s a Catch-22,” Kanelos said. “I want to be able to say, ‘What’s going on? Is there anything wrong with you?’… In the old days, that’s the way I picked up a lot of problems. ... Now, it is hard to figure out what to do.”

-Wes