ISU - Armac Blog

You go to your doctor’s office. They ask you for your copayment. You oblige. All is well in the world. Or is it? Your medical insurance plan might cover your visit at no cost to you, but your doctor’s office keeps requesting a copayment. I recently went for the ever-so-pleasant well-woman exam. Already knowing that my California medical insurance policy was subject to changes in the Patient Protection and Affordable Care Act (PPACA, otherwise known as health care reform or Obama-care), I had mentally prepared myself for battle with the office workers.

My preventative care is covered at 100% and I’m not forking over a single penny. Not in their office, anyway. This added benefit actually raised my medical premium, but let us focus on one thing at a time. Back to the battlefield. I knew my file would indicate that my plan covers office visits after a $35 copayment and they wouldn’t look into it any further. Why should they? It has only been a year since PPACA has taken effect on medical plans. Maybe they aren’t familiar with services being covered at 100%. Or perhaps that was enough time for them to mastermind the copayment hijacking of unsuspected patients.

When I was asked to submit the $35 copayment, I kindly let the employee know that I do not pay anything for preventative care. She replied by saying… nothing at all. She didn’t put up a fight. She had heard this before. Victory was mine. For those of you that don’t deal with insurance on a regular basis, you may not know when and when not to surrender your copayment.  You could very well be giving your doctor money that they are not entitled to.

Some services that are typically covered at 100% are well woman and well baby exams, cholesterol lab work, prostate exams, and mammograms. More information can be found at HealthCare.gov. Not all medical insurance plans are subject to certain elements within the PPACA. Please refer to your plan’s Evidence of Coverage for benefit details.