7 ms·

An annual checkup is one of the certain preventive measures and the Aca does require it to be covered with no cost sharing.

brewdad 3y ago
But the second you mention some new issue that’s cropped up, it no longer coded as an annual checkup and you will be paying. The only way to guarantee a free annual checkup is to go in, say nothing about your state of health, let the dr take your vitals and leave.
- ketzo 3y ago
  Is this universal? In previous annual checkups with my primary care doctor, I have mentioned symptoms as varied as: - recent depression - trouble breathing - irregular heartbeat several of which resulted in follow-up appointments / lab work, but all of which were still covered 100% as annual checkups.
  - hattmall 3y ago
    Do you have an ACA plan or employer provided insurance?? If you can find a doctor that takes your ACA plan then anything other than checking for a pulse is likely to result in some sort of bill.
    - lotsofpulp 3y ago
      Employer subsidized plans are also mostly compliant with ACA. Based on the trends in figure 13.3, I might even say less than 10% of Americans with employer subsidized health insurance are in non ACA compliant plans. https://www.kff.org/report-section/2018-employer-health-benefits-survey-section-13-grandfathered-health-plans/ https://www.kff.org/report-section/2018-employer-health-bene... And I have never had a doctor not accept an ACA compliant plan, which have been in the BCBS network for me. This website seems to have a decent summary of coverage rules: https://www.verywellhealth.com/aca-compliant-health-insurance-5194049 https://www.verywellhealth.com/aca-compliant-health-insuranc... https://www.verywellhealth.com/preventive-care-whats-free-whats-not-1739003 https://www.verywellhealth.com/preventive-care-whats-free-wh...
      - hattmall 3y ago
        I don't mean ACA compliant. I mean actually purchased through the exchange, a.k.a Obamacare. If your employer provided insurance it's good insurance, that's the perk of working there and part of your compensation. If your employer doesn't provide it you have to buy during open enrollment through the exchange and the plans are terrible and expensive.
- refurb 3y ago
  Of course, billing is by procedure done. If you bring up a complaint, it's no longer a preventative check-up, it's addressing a complaint, which has a different billing code and different reimbursement.
nradov 3y ago
Nope. The ACA doesn't classify annual checkups as preventative measures for adults. https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/
- lotsofpulp 3y ago
  I thought #4/5/15 effectively make it an annual check up.

brewdad 3y ago

But the second you mention some new issue that’s cropped up, it no longer coded as an annual checkup and you will be paying. The only way to guarantee a free annual checkup is to go in, say nothing about your state of health, let the dr take your vitals and leave.

ketzo 3y ago
Is this universal? In previous annual checkups with my primary care doctor, I have mentioned symptoms as varied as: - recent depression - trouble breathing - irregular heartbeat several of which resulted in follow-up appointments / lab work, but all of which were still covered 100% as annual checkups.
- hattmall 3y ago
  Do you have an ACA plan or employer provided insurance?? If you can find a doctor that takes your ACA plan then anything other than checking for a pulse is likely to result in some sort of bill.
  - lotsofpulp 3y ago
    Employer subsidized plans are also mostly compliant with ACA. Based on the trends in figure 13.3, I might even say less than 10% of Americans with employer subsidized health insurance are in non ACA compliant plans. https://www.kff.org/report-section/2018-employer-health-benefits-survey-section-13-grandfathered-health-plans/ https://www.kff.org/report-section/2018-employer-health-bene... And I have never had a doctor not accept an ACA compliant plan, which have been in the BCBS network for me. This website seems to have a decent summary of coverage rules: https://www.verywellhealth.com/aca-compliant-health-insurance-5194049 https://www.verywellhealth.com/aca-compliant-health-insuranc... https://www.verywellhealth.com/preventive-care-whats-free-whats-not-1739003 https://www.verywellhealth.com/preventive-care-whats-free-wh...
    - hattmall 3y ago
      I don't mean ACA compliant. I mean actually purchased through the exchange, a.k.a Obamacare. If your employer provided insurance it's good insurance, that's the perk of working there and part of your compensation. If your employer doesn't provide it you have to buy during open enrollment through the exchange and the plans are terrible and expensive.
refurb 3y ago
Of course, billing is by procedure done. If you bring up a complaint, it's no longer a preventative check-up, it's addressing a complaint, which has a different billing code and different reimbursement.

nradov 3y ago

Nope. The ACA doesn't classify annual checkups as preventative measures for adults. https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/

lotsofpulp 3y ago
I thought #4/5/15 effectively make it an annual check up.