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Employers can use open enrollment to educate employees about preventative service visits. If going to the doctor’s office for preventive service visits are supposed to be covered at 100 percent, why do people sometimes later get a bill that shows a balance due and exposes them to copays or deductibles?

When Vikki Brueggeman started frequently fielding this question from Zimbrick Inc. employees, she decided it was time to be more proactive. Brueggeman is Zimbrick’s director of human resources and a former board chair for The Alliance Board of Directors.

A Common Occurrence

Brueggeman said she started hearing about the issue roughly five years ago as more people became aware that the Affordable Care Act (ACA) requires that certain preventive service visits be covered at 100 percent.

“I would hear from employees that they went in for what they thought of as their annual physical and that was supposed to be free under the ACA and they got the bill and it wasn’t free,” Brueggeman said. “Suddenly there were these charges that were being added to their bills.

“It could have been a facility fee or the bill could change because you talked about your knee and that made it a diagnostic visit instead of a preventive services visit.”

After Preventative Service Visits May Be Too Late

Many employees tried calling the doctor’s office after they got the bill to explain there should have been no charge because it was a preventive services visit.

But doctors and their staff often are unaware how much services cost or how they are billed. So patients who call about the issue are typically transferred to “coders” who apply billing codes to the doctor’s notes about the visit.

“That never goes well,” Brueggeman said. “If you wait until afterward instead of being proactive about it, 9 times out of 10 they are going to tell you ‘No.’ ”

Brueggeman added that some health systems add “extra” charges to bills for preventive service visits more often than others. “Even if it’s an unintended consequence of their billing practices, they get more money,” Brueggeman observed.

What to Tell Employees at Open Enrollment About Preventative Service Visits

Brueggeman recommends highlighting the issue as part of open enrollment presentations. Employees have proven receptive to the information.

“I tell employees at open enrollment and share what I say to the doctor at the beginning of my appointment to help keep this problem from occurring,” Brueggeman said.

Brueggeman uses this wording, which she shares with employees at open enrollment and when billing issues arise:

This is my annual physical, which is free for me. If I ask any questions that would make you bill this as a diagnostic visit, please let me know so I can make an informed decision on whether I want you to answer the question or if I’d like to come back another time to discuss it with you.

“Employees’ first reaction is always, ‘Oh, I wish I had known that before I went to the doctor,” Brueggeman said.

Speaking from Personal Experience

Brueggeman has tested the wording during her own visits to the doctor. Once she began making a point of discussing it at the start of the visit, her doctor made it clear she would only bill for a preventive service visit.

The result has been a better relationship with her doctor.

“Suddenly you and your doctor have a more open conversation about what you can and can’t ask,” Brueggeman said. You also have insights into the doctor’s approach.

“You learn their philosophy of how patients should be treated,” Brueggeman said. “That helps you make a more informed consumer choice that confirms this is the right doctor or that tells you that you need to get a different doctor.”

Changing the Conversation

Brueggeman noted that it also helps patients learn that it can be worthwhile to discuss the financial costs of health care with their doctors.

“It makes your doctor aware that you’re aware of how much you’re being charged,” Brueggeman said.

For many patients, asking about billing for preventive service visits may be the first time they bring up the impact of health care costs on their financial health, even if it’s a big issue for their household.

“We don’t always think about the little things we can say that change the course of the conversation,” Brueggeman said. “Your doctor needs to know you’re looking at those bills.”


Benefit Plan Design


Members & Employers


Benefit Plan Design


Members & Employers