Mailbag! Getting nickel-and-dimed at your annual

Hey there —

We’re back with another reader question — this time about why it might look like you got double billed for a routine physical. Plus, two follow-ups on stories we’ve covered before:

• An update on Oregon’s fight against corporate-owned medical clinics.
• New reporting on drug copay assistance programs and the sneaky way insurers claw that money back.

Q: My friends were double-billed for an annual well check. What gives?

Two people I know recently went in for a regular annual physical. The doc asked a couple of questions about prior conditions as part of the discussion during the appointment. Then, the patients were billed for TWO appointments — one physical/wellness visit and one problem visit. In both cases, the doctor initiated, and the patient just answered, but the office billed it as two whole visits because they said the topics weren’t included in a physical. How can they do that? — Nina, NY

I haven’t seen your friend’s specific bills, but this sounds like a classic collision between two things: the Affordable Care Act’s narrow definition of “preventive care” and one of medical billing’s most maddening quirks.

The ACA guarantees a specific list of preventive services at no cost to you: certain tests, bloodwork, and counseling (all depending on your age and certain risk factors), birth control, and immunizations. But it leaves out a lot. A complete blood count, for instance, isn’t on the list.

Here’s the part that likely tripped up your friends: You could potentially get billed for any issue you talk with your doctor about during that visit — a new diagnosis, a chronic condition, or even an innocent question about a weird mark on your arm.

And it doesn’t matter who brings it up first. As Sabrina Corlette, founder and co-director of the Center on Health Insurance Reforms at Georgetown, puts it: “It doesn’t take much to tip an annual well visit into a visit subject to patient cost-sharing.”

Once that happens, with the way billing codes work, those conversations can get lumped into a separate line item from the preventive care — marked “problem visit” — even though you only sat through one appointment. Yep, one visit for the price of two.

There’s another wrinkle worth knowing: For a service to count as preventative, it has to be a routine screening, not a response to symptoms. For example, a lung cancer screening test that the doctor orders because you are due? Preventative. The same test was ordered because you’ve had a sudden cough? Not preventative — it’s diagnostic, and it’s billed differently.

If this feels un-bill-ievable… yeah. You aren’t alone.

Jokes aside, if your annual is coming up, and now you’re feeling sorta nervous, we have a First Aid Kit that walks you through all of this in more detail, including tips for fighting back if you think you’ve been billed improperly.

Oregon’s new law scares off ER takeover

At the end of last year, Dan and Emily reported on some not-so-terrible things that happened in 2025.

One highlight: Oregon closed loopholes in its ban on corporate-owned medical practices, making it harder for investors to buy up clinics and squeeze them for profits.

That new law recently got its first test — and it worked. Independent physician group Eugene Emergency Physicians sued to block PeaceHealth, a local hospital system from replacing them withApolloMD, a national staffing company, arguing the move violated the new rules.

As NPR reported, physicians across the state were watching closely. During the hearing, the federal judge questioned whether ApolloMD’s ownership structure amounted to “a shell game,” and even accused two Apollo witnesses of dishonesty.

That seemed to be enough to scare off the takeover. The hospital and Apollo dropped the deal soon after.

Beware these insurance programs that clawback prescription drug savings

Last up: A story from KFF Health News on “copay accumulators” — a program that sounds boring but costs real money.

Here’s the setup: If you’re on an expensive medication and have a high deductible, you may qualify for a coupon card or patient assistance program — discounts, sometimes worth thousands of dollars, that drugmakers offer to help cover out-of-pocket costs. As we reported a few years back, that assistance may even come in the form of a prepaid debit card.

That kind of help can be lifesaving. But it’s not exactly altruistic on the part of drugmakers. If a manufacturer covers your costs for a month or two until you hit your deductible, your insurance is more likely to pay out for the rest of the year.

Now, insurance companies are onto pharma’s gambit, and copay accumulators are their countermove.

When you use that coupon card at the pharmacy, your insurer pockets the money, and none of it counts toward your deductible — leaving you right back where you started.

More states are catching onto these shenanigans and banning accumulators — good news if you live in one of those states and have a state-regulated insurance plan. You’ll find an interactive chart of the 26 states (plus Washington D.C. and Puerto Rico) with copay accumulator regulations currently on the books towards the bottom of the KFFHN article.

But most of us do not have a state-regulated insurance plan. And finding out what your insurance plan allows before you sign up can be tough — and that’s assuming they don’t change the rules on you midyear, which they can totally do (ugh).

But it’s well worth a try if you rely on copay assistance. Back in 2022, staff from the nonprofit Aids Institute shared a tipsheet with us that they created to help guide your search.

That’s all from me for now. We’ll catch you next week with a brand new episode of the podcast.

— Claire