First time Medicare question

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retire14
Posts: 222
Joined: Sun Jan 04, 2015 10:27 am

First time Medicare question

Post by retire14 » Fri Jan 12, 2018 5:29 pm

So I just had a "Welcome to Medicare" exam and got a bill from my physician for $183. I complained and they told me that Medicare paid for the physical, but the dr talked to me about some chronic conditions during that visit and they wanted to bill me for that. I had no chronic conditions. I only asked simple questions about my health as part of the routine exam. In the past (when I was under emplyer-sponsored insurance), I did not have to pay anything extra for a physical and the dr never billed extra for the visit.

Is this unique to Medicare? Are you paying an extra $183 just for the annual check-up under Medicare? How do I fight this? The dr office said they stand by their charges. I am mad. Seemed like a scheme to charge more for Medicare patients.

jebmke
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Re: First time Medicare question

Post by jebmke » Fri Jan 12, 2018 5:41 pm

It may have more to do with the office billing policy. I had a physical (non medicare) last month. They gave me a financial disclosure that indicated that they would bill separately if there were any specific medical issues addressed in the physical. My insurance covers the cost of the physical.
When you discover that you are riding a dead horse, the best strategy is to dismount.

dbr
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Re: First time Medicare question

Post by dbr » Fri Jan 12, 2018 5:52 pm

Apparently the doctor supplied services not covered by the Medicare wellness exam without carefully explaining that was what he was doing. I don't know if it was out of line that those services were appropriate, but there should have been an explanation of costs.

But the real question is why you do not also have Medigap insurance to cover additional costs and then to investigate if those additional services would then be covered.

I have never experienced any Medicare/Medigap treatments in the doctors office that were not pretty much fully covered. A family member has Medicare and supplemental coverage through Federal Employees Health Benefits and has all kind of issues that are treated with no additional cost to him. FEHB costs him a monthly premium, as does Medigap if you have a plan. The same could be for people with other kinds of retiree supplemental insurance that is not Medigap.
Last edited by dbr on Fri Jan 12, 2018 5:57 pm, edited 1 time in total.

sport
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Location: Cleveland, OH

Re: First time Medicare question

Post by sport » Fri Jan 12, 2018 5:56 pm

retire14 wrote:
Fri Jan 12, 2018 5:29 pm
I complained and they told me that Medicare paid for the physical, but the dr talked to me about some chronic conditions during that visit and they wanted to bill me for that. I had no chronic conditions.
You may want to think about finding another doctor.

Katietsu
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Re: First time Medicare question

Post by Katietsu » Fri Jan 12, 2018 5:57 pm

This has to do specifically with the parameters of the “Welcome to Medicare” exam. This is not the first time this has been discussed here.

Here is a link that discusses what is included. https://www.medicareinteractive.org/get ... tive-visit

As stated this is a preventative visit and is NOT a full physical exam or a visit to address a particular current problem.

Based on the significant number of surprised patients, I do not think this is usually explained very well. In other words, if you want an annual exam or to talk about specific health problems, that is a different service than “Welcome to Medicare.”
Last edited by Katietsu on Fri Jan 12, 2018 6:00 pm, edited 1 time in total.

dbr
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Re: First time Medicare question

Post by dbr » Fri Jan 12, 2018 5:58 pm

Katietsu wrote:
Fri Jan 12, 2018 5:57 pm
This has to do specifically with the parameters of the “Welcome to Medicare” exam. This is not the first time this has been discussed here.

Here is a link that discusses what is included. https://www.medicareinteractive.org/get ... tive-visit

As stated this is a preventative visit and is not a full physical exam or a visit to address a particular current problem.

Based on the significant number of surprised patients, I do not think this is usually explained very well.
Right. It is hard to tell if the doctor leveraged unnecessary costs out of the visit or legitimate charges.

retire14
Posts: 222
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Re: First time Medicare question

Post by retire14 » Fri Jan 12, 2018 6:09 pm

dbr wrote:
Fri Jan 12, 2018 5:52 pm
Apparently the doctor supplied services not covered by the Medicare wellness exam without carefully explaining that was what he was doing. I don't know if it was out of line that those services were appropriate, but there should have been an explanation of costs.

But the real question is why you do not also have Medigap insurance to cover additional costs and then to investigate if those additional services would then be covered.

I have never experienced any Medicare/Medigap treatments in the doctors office that were not pretty much fully covered. A family member has Medicare and supplemental coverage through Federal Employees Health Benefits and has all kind of issues that are treated with no additional cost to him. FEHB costs him a monthly premium, as does Medigap if you have a plan. The same could be for people with other kinds of retiree supplemental insurance that is not Medigap.
I do have Medigap. I will ask if they can bill this to Medigap

jebmke
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Re: First time Medicare question

Post by jebmke » Fri Jan 12, 2018 6:12 pm

The $183 is conspicuously the same as the Part B deductible. If you have Plan F, the gap insurance may cover it. If you have G it is probably on you.
When you discover that you are riding a dead horse, the best strategy is to dismount.

dbr
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Re: First time Medicare question

Post by dbr » Fri Jan 12, 2018 6:15 pm

retire14 wrote:
Fri Jan 12, 2018 6:09 pm
dbr wrote:
Fri Jan 12, 2018 5:52 pm
Apparently the doctor supplied services not covered by the Medicare wellness exam without carefully explaining that was what he was doing. I don't know if it was out of line that those services were appropriate, but there should have been an explanation of costs.

But the real question is why you do not also have Medigap insurance to cover additional costs and then to investigate if those additional services would then be covered.

I have never experienced any Medicare/Medigap treatments in the doctors office that were not pretty much fully covered. A family member has Medicare and supplemental coverage through Federal Employees Health Benefits and has all kind of issues that are treated with no additional cost to him. FEHB costs him a monthly premium, as does Medigap if you have a plan. The same could be for people with other kinds of retiree supplemental insurance that is not Medigap.
I do have Medigap. I will ask if they can bill this to Medigap
If you have Medigap then they should have taken your policy information and done that as a matter of course. You should not have to ask. It might be you would be better off working with a clinic that is more professional in the business office than this one. When you complained about the bill they should have asked if you had other coverage. Most people would.

Mitchell777
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Re: First time Medicare question

Post by Mitchell777 » Fri Jan 12, 2018 6:33 pm

I just had a physical yesterday (not Medicare). On the receipt they gave me it noted that we discussed two things that we did not discuss. I do not know if they were left overs from some prior visit but we had not discussed those two items in years. These annual physicals are to be no charge. I'll be bothered if I receive a bill.

Nowizard
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Re: First time Medicare question

Post by Nowizard » Fri Jan 12, 2018 6:49 pm

Sounds like some here have a doctor with a very different billing set than mine. However, if the doc billed you for services other than the introductory physical, he should bill Medicare for those services and, in turn, any supplementary insurance you carry. That should pay your bill, but you will have the Medicare deductible that has been mentioned by others. Another view might simply be that you will have to pay the deductible for Medicare anyway, so it makes little difference if it is to one doctor or another so long as the billed services have been submitted appropriately to your insurance companies.

Tim

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heartwood
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Re: First time Medicare question

Post by heartwood » Fri Jan 12, 2018 6:55 pm

jebmke wrote:
Fri Jan 12, 2018 6:12 pm
The $183 is conspicuously the same as the Part B deductible. If you have Plan F, the gap insurance may cover it. If you have G it is probably on you.
+1 https://www.medicare.gov/your-medicare- ... lance.html

I'm intrigued by the discussion. My doctor only accepts medicare, with any deductible or remainder going to my secondary insurance. It was years ago and I don't recall specifics of my Welcome to Medicare visit, but I do go to my PCP (or any other doctor) at least 2x a year to manage my meds and any items I want to discuss. He submits to Medicare with his codes. They pay, minus the annual deductible, minus the 20% "copay". Medicare then submits directly to my secondary. Since my PCP only takes medicare I pay an annual deductible for my secondary since he's out of network. For other in-network docs I pay no annual secondary deductible, just a copay. I'm responsible for paying any balance to my PCP.

westie
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Re: First time Medicare question

Post by westie » Fri Jan 12, 2018 7:17 pm

Something seems wrong here. If you have supplemental insurance it should cover what Medicare doesn't. I started Medicare in August, haven't been asked to pay a dime and I've had CT scans, MRI's, visits with specialist in another state etc etc.

dbr
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Re: First time Medicare question

Post by dbr » Fri Jan 12, 2018 7:22 pm

westie wrote:
Fri Jan 12, 2018 7:17 pm
Something seems wrong here. If you have supplemental insurance it should cover what Medicare doesn't.
Apparently the office didn't file against his supplemental coverage. Apparently they didn't know he had it, didn't ask him for it, or just couldn't be bothered.

Another issue is that some offices send out billings even though it can take two or three billing cycles before Medicare and the Medigap carrier actually pay off. Those billings may show that insurance is pending or the office is just being ornery and asking for the money, which will be refunded when insurance pays. The solution is to inquire what is going on.

Good Listener
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Re: First time Medicare question

Post by Good Listener » Fri Jan 12, 2018 8:20 pm

Do not despair. This is good. The 183 is the Medicare part B deductible. So you got the annual wellness visit, in this case welcome to Medicare, and then the other parts of the physical were billed and approved. That's good. Your deductible is now satisfied. The office is billing properly. I will have this visit soon and make sure my PCP understands I want the full physical not just welcome to Medicare, which is very minimal. I happen to have plan F so that will all be covered. You have plan G I bet. G makes more sense than F but I didn't want to deal with the deductible even.

Shallowpockets
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Re: First time Medicare question

Post by Shallowpockets » Sat Jan 13, 2018 7:06 am

The wellness check has become a scam. It is so easy for a doctor to ask an open ended question and then you go into non covered areas. So they ask and do all the things per medicare coverage, none of which you actually know are part and parcel of that free wellness check. Then it is so easy for the patient to mention some problem they noticed and, BOOM, you are into a regular physical territory. Thus increased billing.
Best thing is to only answer questions. Offer nothing more.
Best thing is to not even go to have a wellness check. You can take your weight and blood pressure at the gym. Because outside of that you are skirting the limits of the free wellness check.
Oftentimes, the extra billed part is only talking points. Nothing is actually done.
This free wellness check is almost like a teaser advertisement to get you into there once a year.

Ret2018
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Re: First time Medicare question

Post by Ret2018 » Sat Jan 13, 2018 10:00 am

You might think about finding a different doc. Electronic records have made it even easier for docs to "upcode" the charges for a physical exam--just search on "billing E&M." There are different levels of exam, each with higher reimbursement rates.

From CMS guidance:
"For example, a problem focused history requires documentation of the chief complaint (CC)
and a brief history of present illness (HPI), while a detailed history requires the
documentation of a CC, an extended HPI, plus an extended review of systems (ROS),
and pertinent past, family, and/or social history (PFSH)."

Fill out a scanner form or talk with an assistant about symptoms/history unrelated to the reason for your visit (eg, "do you or your family have a history of....")? Boom, you just completed an "extended review of systems" and the doc can bill for a higher level of service.

Same thing happens all the time with colonoscopies, doc billing and commercial insurance coverage. Go in for a "preventive screening" colonoscopy (a no co-pay service under ACA), have a polyp removed, and now it's a "diagnostic" colonoscopy that's billed at a higher reimbursement rate AND you now have a co-pay.

dbr
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Re: First time Medicare question

Post by dbr » Sat Jan 13, 2018 10:08 am

Ret2018 wrote:
Sat Jan 13, 2018 10:00 am


Same thing happens all the time with colonoscopies, doc billing and commercial insurance coverage. Go in for a "preventive screening" colonoscopy (a no co-pay service under ACA), have a polyp removed, and now it's a "diagnostic" colonoscopy that's billed at a higher reimbursement rate AND you now have a co-pay.
Except that eschewing the polyp removal may be a death sentence.

People can make their own judgement about the wellness exam but one might consider that at Medicare age it is worth investigating more than what is provided there especially if one has concerns or a history. This whole complaint seems puzzling considering that the OP even admits to carrying Medigap insurance.

Lynette
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Re: First time Medicare question

Post by Lynette » Sat Jan 13, 2018 10:26 am

Did you talk to Medicare about that? I went to the "Welcome to Medicare" exam and I got a letter from Medicare telling me what they would not cover everything and outlined the maximum that the doctor could bill me. In my case the doctor's office got the billing code wrong as I did not retire at the usual 65. In addition the doctor whom I have had for over 20 years did not ask all of the required questions - e.g. am I depressed, etc. The doctor also did not give me another EKG - gave me one the year before for my company's required wellness test. I don't like Medicare so I appealed this and lost. My doctor did not bill me anything further.

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