Her routine Pap smear was meant to be covered as preventive care — until one abnormal 2024 result led to a $1,000 charge

“Just because I have a potential for having cancer, I have to pay,” Penny Rose said.

Her annual Pap smear was supposed to be marked as preventive care — but was hit with a $1,000 bill because of one abnormal result from 2024 — Doctor handing a report to a female patient (Representative Cover Image Source: Pexels | Photo by Gustavo Fring)

A routine checkup is supposed to be free under the Affordable Care Act. But when Penny Rose (@butmybackhurts) went in for a recent appointment, she found herself caught in the tangled world of American healthcare. Because she had received an abnormal result from a prior Pap smear, she was billed $1,000, and what she expected to be preventive care became an expensive diagnostic visit. Her Instagram reel about the experience drew more than 90,000 views.

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Preventive care, apparently not

Rose said in the video that she received a $1,000 bill from a Dartmouth clinic after a Pap smear. She told a billing technician that she has the test every year as preventive care, following an abnormal result in a previous exam. She understood that preventive services are covered by insurance. Instead, the technician told her that because of the earlier abnormal finding, future Pap smears would be treated as “diagnostic” rather than preventive. “So because I have a potential for having cancer, I have to pay. If I had normal Pap smear results, I wouldn’t have to pay,” Rose said.

Her routine Pap smear was meant to be covered as preventive care — until one abnormal 2024 result led to a $1,000 charge — Medical technician showing bill to a woman (Representative Image Source: Pexels | Photo by RDNE Stock Project)

A routine Pap smear is generally covered in full by most insurance plans, according to CareRoute. That includes “a Pap every 3 years for women 21 to 65, or a Pap plus HPV co-test (or primary HPV test) every 5 years for women 30 to 65.” But there are situations in which the test can generate a bill, such as when it is performed outside the recommended schedule, when an abnormal result is involved, or when symptoms lead to a diagnostic exam. Once the test is coded as “diagnostic,” standard charges apply.

“It’s insane”

Rose’s video sparked an extended discussion about Pap smears and insurance billing. Responses were mixed. @sarah.boardman.design wrote, “Your gynecologist needs to recode it. Resubmit.” @luke.mitch315 commented, “Insurance doesn’t exist to improve health; it only exists to make money. If health was the goal, you would pay a doctor each month, and they would treat you when needed.” @mcq819 added, “Same thing with mammograms. Once there’s an issue and a diagnostic code is assigned, you pay for it.”