Why am I Being Charged for Services That Were Part of My Annual Visit or Preventive Care?

August 2014


The Affordable Care Act expanded coverage for preventive care and screening services. It eliminated the assessment of co-pays, co-insurance amounts, and deductibles for preventive, well care, annual exams and certain preventive screenings when it is determined that these services are being provided to prevent illness and detect first signs of disease. 

The United States Preventive Services TaskForce (USPSTF) A and B Recommendations is a list of preventive and screening services that are available to patients in ACA-qualified plans not subject to deductibles, co-pays or co-insurance. ACA-qualified health plans and insurers may require a co-payment or a deductible for some of the laboratory tests and services not included on the list of USPTF recommendations. Insurance companies are only required to cover services that are classified as preventive and found on the USPSTF recommendations list. 

If your doctor believes that ordering one or more of the recommended services is medically necessary, then you may be eligible to receive these services free of any deductible, co-insurance or co-pay. However, if you were previously treated for a disorder or have a known ailment, then some of the tests may be considered diagnostic or specifically related to the treatment of your condition or disease and not ordered by the physician as a preventive or screening service. In that situation, you may be subject to a deductible, co-payment or co-insurance. 

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