QUESTION

I went to my doctor’s office for a flu shot, but was charged for an office visit. I thought preventive services were covered without co-pays. How can that be?

Post enrollment issues | Individual Health Insurance
ANSWER

Influenza or flu shots are one of the recommended preventive services that insurers must cover without cost-sharing as long as the shot is provided by an in-network provider. Whether the insurer has to cover the office visit, however, depends on whether there was a medical reason other than prevention for your doctor’s visit. So if your flu shot wasn’t part of your annual physical, the office visit is not a preventive service. See this FAQ for more on preventive services (45 CFR § 147.130(a)(2)).

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Post enrollment issues