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
'Just because I have a potential for having cancer, I have to pay,' Penny Rose remarked.
A routine checkup is supposed to be free under the Affordable Care Act. But when Penny Rose (@butmybackhurts) went for a checkup recently, she found herself whirlpooling in the tempestuous labyrinth of American healthcare. Just because she had gotten an abnormal result in a 2024 Pap smear exam, she was given a bill of $1,000, and her regular preventive care checkup was turned into a costly diagnostic trip. Her November 3, 2026, Instagram reel detailing the incident has been viewed over 90,000 times.
Preventive care, apparently not
Rose started the video by sharing that she got a massive bill of $1,000 from a Dartmouth clinic where she underwent a Pap smear. She clarified to a billing technician that she gets a Pap smear every year as preventive care after a 2024 evaluation showed some abnormal results. She knew that preventive care is always covered under insurance. The technician, however, told her that because she had abnormal results once, every Pap smear would now be considered “diagnostic” and not preventive care. “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, perturbed.
A routine Pap smear is 100% free on most insurance plans, as CareRoute also explains. This 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 certain scenarios where it comes with a bill; for example, if it is done off-schedule, it indicates an abnormal result, or if symptoms are diagnosed, it becomes diagnostic. Once the examination is labelled as “diagnostic,” all the charges apply.
'It's insane'
Her video spurred a protracted discussion on the Pap smear and the payment rules. People responded with mixed reactions. @sarah.boardman.design said, “Your gynecologist needs to recode it. Resubmit.” @luke.mitch315 added, “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 shared, "Same thing with mammograms. Once there’s an issue and a diagnostic code is assigned, you pay for it."
You can follow Penny Rose (@butmybackhurts) on Instagram for more lifestyle stories.
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