[lotsofpulp]

> If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact.

In the case of annual checkups, I believe insurance companies are required to cover them 100% by the Affordable Care Act:

https://www.hhs.gov/healthcare/about-the-aca/preventive-care...

[nradov]

The ACA doesn't require insurers to cover annual check ups at 100%. Only certain preventative measures are covered that way.

[billy_bitchtits]

An annual checkup is one of the certain preventive measures and the Aca does require it to be covered with no cost sharing.

[brewdad]

But the second you mention some new issue that’s cropped up, it no longer coded as an annual checkup and you will be paying.

The only way to guarantee a free annual checkup is to go in, say nothing about your state of health, let the dr take your vitals and leave.

[ketzo]

Is this universal?

In previous annual checkups with my primary care doctor, I have mentioned symptoms as varied as:

- recent depression

- trouble breathing

- irregular heartbeat

several of which resulted in follow-up appointments / lab work, but all of which were still covered 100% as annual checkups.

[hattmall]

Do you have an ACA plan or employer provided insurance??

If you can find a doctor that takes your ACA plan then anything other than checking for a pulse is likely to result in some sort of bill.

[lotsofpulp]

Employer subsidized plans are also mostly compliant with ACA. Based on the trends in figure 13.3, I might even say less than 10% of Americans with employer subsidized health insurance are in non ACA compliant plans.

https://www.kff.org/report-section/2018-employer-health-bene...

And I have never had a doctor not accept an ACA compliant plan, which have been in the BCBS network for me.

This website seems to have a decent summary of coverage rules:

https://www.verywellhealth.com/aca-compliant-health-insuranc...

https://www.verywellhealth.com/preventive-care-whats-free-wh...

[refurb]

Of course, billing is by procedure done.

If you bring up a complaint, it's no longer a preventative check-up, it's addressing a complaint, which has a different billing code and different reimbursement.

[nradov]

Nope. The ACA doesn't classify annual checkups as preventative measures for adults.

https://www.healthcare.gov/preventive-care-adults/

[lotsofpulp]

I thought #4/5/15 effectively make it an annual check up.