{"id":291,"date":"2025-04-30T09:00:00","date_gmt":"2025-04-30T09:00:00","guid":{"rendered":"http:\/\/www.liseshopcol.com\/?p=291"},"modified":"2025-05-05T11:07:07","modified_gmt":"2025-05-05T11:07:07","slug":"the-patient-expected-a-free-checkup-the-bill-was-1430","status":"publish","type":"post","link":"http:\/\/www.liseshopcol.com\/index.php\/2025\/04\/30\/the-patient-expected-a-free-checkup-the-bill-was-1430\/","title":{"rendered":"The Patient Expected a Free Checkup. The Bill Was $1,430."},"content":{"rendered":"

Carmen Aiken of Chicago made an appointment for an annual physical exam in July 2023, planning to get checked out and complete some blood work.<\/p>\n

The appointment was at a family medicine practice run by University of Illinois Health. Aiken said the doctor recommended they undergo a Pap smear, which they hadn’t had in more than a year, and testing for sexually transmitted infections. Aiken, who works for a nonprofit and uses the pronoun they, said they were also encouraged to get the HPV vaccine.<\/p>\n

They’d tested positive for HPV in 2019 and eventually cleared the virus but had not received the vaccine to prevent future infections.<\/p>\n

“Sounds like a good idea,” Aiken, 37, recalled telling the doctor.<\/p>\n

They also needed some lab work done, part of routine monitoring for one prescription. After being examined, Aiken said, they were directed to a different part of the office building to get blood drawn and receive the first dose of the vaccine before leaving.<\/p>\n

Then the bill came.<\/p>\n

The Medical Procedure<\/strong><\/p>\n

Services at Aiken’s appointment included a pelvic exam, a vaccination, and blood work, checking, in part, glucose levels and liver function.<\/p>\n

An annual physical exam typically includes a variety of services, many of which insurers are required to cover<\/a> under the Affordable Care Act, such as reviewing the patient’s health history, screening for high cholesterol, or performing a Pap smear, a procedure to check the cervix for signs of cancer.<\/p>\n

Updating immunizations is also a common, covered service at checkups. The vaccine for HPV, or the human papillomavirus, provides protection against an infection that can cause several types of cancer. Federal health officials recommend<\/a> being immunized for HPV at age 11 or 12, though the vaccine also can be administered later in life.<\/p>\n

The Final Bill<\/strong><\/p>\n

$1,430.13: $1,223.22 for lab services and pathology, plus $206.91 for “professional services,” which included a charge for a 40-minute “High Mdm” outpatient visit \u2014 indicating a high level of “medical decision-making” \u2014 as well as charges for immunization administration and vaccines.<\/p>\n

The Billing Problem: Diagnostic Blood Work With a Hospital Price Tag<\/strong><\/p>\n

Not all services that may be provided as part of an annual physical are paid for by insurance as preventive care.<\/p>\n

A patient who needs blood work for a specific medical concern \u2014 as Aiken did, for medication monitoring \u2014 could be required to pay part of the bill. That’s the case even if the blood work is performed during a checkup alongside preventive services. Some health insurers pay for standard blood work as part of a preventive visit, but that’s not always the case.<\/p>\n

Aiken had purchased a health insurance plan on the federal marketplace and said they were confident the visit would be covered at no cost to them.<\/p>\n

When they got a bill for more than $1,400, Aiken thought, “How did this happen?” They said they called their insurer, BlueCross BlueShield of Illinois, then filed an appeal for the $1,223.22 amount they owed for lab services after their initial inquiry went nowhere. “Surely this is a misunderstanding.”<\/p>\n

But their insurer sided with UI Health’s position that the blood work rendered during the appointment was not preventive. In a letter denying Aiken’s appeal, BlueCross BlueShield of Illinois decided that “the labs were billed correctly as diagnostic.”<\/p>\n

Under the plan’s parameters, the insurer determined Aiken remained on the hook for 50% of the cost of outpatient labs performed in a hospital setting.<\/p>\n

Dave Van de Walle, a spokesperson for BlueCross BlueShield of Illinois, would not discuss Aiken’s bill with KFF Health News.<\/p>\n

Francesca Sacco, a spokesperson for UI Health, said in an emailed statement that Aiken scheduled the appointment for “medication monitoring and to obtain a vaccine.”<\/p>\n

“Medication monitoring is not considered a wellness benefit under the Affordable Care Act,” she said.<\/p>\n

Sacco also said Aiken’s labs were sent for processing to University of Illinois Hospital, more than a mile away from the family medicine practice.<\/p>\n

That left Aiken owing more. Hospitals typically charge much more<\/a> than physicians’ offices or independent commercial labs for the same tests.<\/p>\n

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