How to avoid surprise doctor's bills

HOUSTON – If you have health insurance, most preventative care is free like vaccinations, well-woman visits and, for most plans, your annual check-up. But one man asked consumer expert Amy Davis for an explanation when his doctor stuck him with hundreds of dollars in bills. 

"The doctor came in," patient Tim Cifelli-Volmer said. "They did the normal things. And then he said, 'OK, we're gonna draw blood. And I need you to schedule an appointment to come back in two weeks to go over the results.'"  

Cifelli-Volmer did just as his doctor asked at his annual check-up. He scheduled his next appointment, had his blood drawn and showed up two weeks later. Before he could see the doctor, a woman at the front desk told him he owed $100. 

"So I looked at the woman and I said, 'I'm confused. Why am I paying $100? My insurance says that I get my wellness exam.' She said, 'Well, this isn't considered part of your wellness exam. This is an office visit.'" 

His said his visit with the doctor was brief. 

"I paid $100 for the doctor to tell me in three minutes, 'Everything's fine,' and that's it," Cifelli-Volmer said.  

"Somehow this physician is actually turning that preventative visit into additional income in their business," said Dr. Vivian Ho, the chair of Health Economics for Rice Univerity's Baker Institute. "I'm stunned. I haven't heard of that happening before; and I talk to a lot of people about their healthcare and preventive healthcare visits."

Cifelli-Volmer complained to his insurance company Aetna, but he said a representative told him there was nothing they could do. 

"They're making lots of money by dividing your office visit into two parts," he said. "The first part is the physical and the second part they're considering a follow-up, which is really just to get your lab results." 

"If healthcare providers are gonna behave like this, we are gonna have to be our own smartest consumer and ask as many questions as we can think of," Ho said.  

But be careful what you ask during your visit. 

  • It is true that mentioning any ailment or concern during your routine check-up could trigger a co-pay, because some doctors code it as a diagnostic visit in addition to your check-up. 
  • Before raising any additional issues, you might ask your doctor if such a question would result in a co-pay or an additional charge. 
  • Call your insurance company before your check-up to ask which screenings and tests are covered and which are not. 

Cifelli-Volmer's doctor ordered a blood test that his insurance plan would only pay for if he were 45 years old. That got him another bill from the lab for $125. 

"With the exorbitant amount of health care costs, you need to question everything," he said. 

If your doctor, like his, asks you to make an appointment for a follow-up visit to review test results before the test has even been done, you should ask if you can just see the results online or if the doctor can call you if the tests show some irregularity that you need to discuss.