I had a women’s wellness visit with my regular doctor, who my insurance provider moved out of network. When I got the bill showing I was responsible for the entire amount, I called my insurance provider who said they would make an exception and adjust the claim. It turns out they only paid a small portion and I am still being held responsible for a large amount.

I called them again and they are claiming it was a one time adjustment and they cannot go back and make another one. With women’s wellness being covered under the ACA, shouldn’t the full amount have been covered when they made the adjustment? Are procedures that are covered under the ACA still covered when a doctor is out of network?


Free preventive services are only covered in-network. Some plans may cover part or all of the costs out-of-network, but this is an exception to the rule. You can still appeal the insurance companies decision if you feel that you were led to believe by the insurer that your doctor was in-network.

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Bret on

This does not fit my question exactly, but your “ask a question” form is shut down – this seems to be the closest fit I can find: I am a High School Football Coach in a small town… Until a couple of years ago, a local doctor would offer free sports-physicals to all our student-athletes. I am assuming they would then write these services off as donations. In 2012, the doctor stopped offering this great community service by saying that Obamacare made it impossible. This seemed like pretty obvious scapegoating to me, so my questions is this:

Does the ACA prevent or discourage doctors from donating services?

ObamaCareFacts.com on

Good question. If so it is buried in the later sections of the ACA or in everyones favorite reading material “the federal register”. I don’t know of any ruling that would imply this, but that doesn’t mean it isn’t the case.

You can check out this in-depth summary where each section is explained in plain english. Maybe there is something in there (use command find to search for terms, it is long): https://obamacarefacts.com/summary-of-provisions-patient-protection-and-affordable-care-act/