What Happens When Preventive Care Leads to Medical Bills?

Jenifer Dorsey
July 19th, 2019 September 16th, 2016 |
Read time: 8 minutes

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Paying for unexpected healthcare + tests after no-cost screenings

Your Obamacare plan provides you with access to many preventive care benefits at no additional cost beyond your health insurance premium, as outlined by the Affordable Care Act. These covered services include screenings, counseling, and immunizations recommended by the U.S. Preventive Services Task Force and your healthcare provider.

But what happens when, for instance, your breast cancer mammography screening or colorectal cancer screening require additional testing and treatment?

Depending on your health insurance benefits, you could be responsible for some or all of your follow-up care. You may need to pay toward your health plan deductible, coinsurance, copayment and services not covered by your health plan.

Michelle Andrews recently addressed this topic in her Kaiser Health News series, and one expert stated that cost is always the number one factor that discourages people from getting tested for colorectal cancer.1

Don’t skip office visits to save money

Skipping healthcare to avoid medical bills can be tempting when you’ve been feeling fine. However, it is recommended that all adults, even healthy ones, routinely visit their healthcare provider.2 Putting it off may have consequences. As the term suggests, preventive care can help prevent illnesses before they cause symptoms or problems and detect illness at an early stage when it is likely more treatable.3,4

4 ways to address healthcare costs + manage your budget

If additional healthcare costs concern you, here are a few things you can do before—and even after—the bills show up.

1. Check with your health insurance regarding plan benefits

When in doubt, call your health insurance plan’s member services number. Even if you think your preventive care visit won’t cost a dime beyond your premium (e.g., it says so at HealthCare.gov), it doesn’t hurt to confirm with your health insurance company. Provider networks and other factors may impact what you owe, if anything, for preventive services.

If you need additional care and testing, you could be billed. Again, your health insurance company can help you understand your benefits and your financial responsibility.

2. Purchase supplemental benefits to help with out-of-pocket costs

This is something to consider ahead of time, perhaps when you are purchasing health insurance for the upcoming year. Supplemental health benefits such as critical illness plans and medical gap plans, pay lump-sum cash benefits for covered conditions and medical events.

What’s critical illness coverage?

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A medical gap plan may be right for you.

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Work with a licensed health insurance producer to determine which benefits can help you and your family maximize your healthcare dollars – call the number at the top of your screen to speak with one.

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3. Discuss options with your doctor to determine the best course of treatment

If costs concern you, discuss it with your healthcare provider. This individual can help advise you regarding what care and treatment should be received right now, and what can possibly wait. They may also connect you with the clinic or hospital billing department to discuss pricing, payment option and other matters related to the financial aspect of care.

4. Work with a patient advocate

A medical billing advocate or claim assistance professional can work with you to review medical bills and ensure their accuracy as well as help you reduce costs. These individuals work with insured and uninsured people.

The time for preventive care is now

As open enrollment nears, it can be a good time to visit your healthcare provider for preventive care. This is a way to take advantage of your current health insurance plan, and get ready for open enrollment.

Preventive care screenings can help you anticipate your potential healthcare needs for the year ahead, which can help you choose the most appropriate health plan for 2017 during open enrollment.


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Originally Published On September 16th, 2016
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