Knowing that would cost her $700, and knowing her doctor had ordered a screening mammogram, Thomas stood her ground.
"Either I get a screening today or I'm putting my clothes back on and I'm leaving," she remembers telling the hospital staff. It worked. Her mammogram was counted as preventive and she got it for free.
"A lot of women ... are getting labeled with that diagnostic code and having to pay year after year for that," Thomas said. "It's a loophole so insurance companies don't have to pay for it."
For parents with several children, costs can pile up with unexpected copays for kids needing shots. Even when copays are inexpensive, they can blemish a patient-doctor relationship. Robin Brassner of Jersey City, N.J., expected her doctor visit to be free. All she wanted was a flu shot. But the doctor charged her a $20 copay.
"He said no one really comes in for just a flu shot. They inevitably mention another ailment, so he charges," Brassner said. As a new patient, she didn't want to start the relationship by complaining, but she left feeling irritated. "Next time, I'll be a little more assertive about it," she said.
How confused are doctors?
"Extremely," said Cheryl Gregg Fahrenholz, an Ohio consultant who works with physicians. It's common for doctors to deal with 200 different insurance plans. And some older plans are exempt.
Should insurance now pay for aspirin? Aspirin to prevent heart disease and stroke is one of the covered services for older patients. But it's unclear whether insurers are supposed to pay only for doctors to tell older patients about aspirin — or whether they're supposed to pay for the aspirin itself, said Dr. Jason Spangler, chief medical officer for the nonpartisan Partnership for Prevention.