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Re: Medicare annual physical vs wellness visit

Posted: Tue Mar 19, 2019 8:35 am
by jkrm
If you have a Medigap plan (I am thinking F or G), wouldn't that pick up the cost of a physical? Or are you still stuck with just an annual wellness visit?

Re: Medicare annual physical vs wellness visit

Posted: Tue Mar 19, 2019 10:32 am
by Lynette
drawpoker wrote: Mon Mar 18, 2019 3:24 pm
Lynette wrote: Mon Mar 18, 2019 1:30 pm .....referral for a bone density test.....
If you are female when you first go on Medicare the bone density scan is one of the "free" screenings you get automatically (no referral needed)

Did you not get this during your first year......?
Yes, my doctor gave a referral for a bone density test. The coverage I had through my employer was an HMO. I am pre-osteoporosis (whatever that is called) which is why I am on Prolia. I think that if one is diagnosed as potentially having osteoporosis one can go for a bone density every two years. I have been taking Prolia for two years so I think that I am entitled to another scanning. I have to go to a hospital for an injection of Prolia so that Medicare will pay for it. Again I'm sceptical if anything can really strengthen my bones at my age. I do plank exercises in Yoga and pilates and like to row on a Concep2 at my Health Club. As far as I'm concerned that is all that I can do? Drugs or Calcium and Vitamin D help? I don't know. I doubt it.

Re: Medicare annual physical vs wellness visit

Posted: Tue Mar 19, 2019 10:55 am
by dm200
Lynette wrote: Tue Mar 19, 2019 10:32 am
drawpoker wrote: Mon Mar 18, 2019 3:24 pm
Lynette wrote: Mon Mar 18, 2019 1:30 pm .....referral for a bone density test.....
If you are female when you first go on Medicare the bone density scan is one of the "free" screenings you get automatically (no referral needed)

Did you not get this during your first year......?
Yes, my doctor gave a referral for a bone density test. The coverage I had through my employer was an HMO. I am pre-osteoporosis (whatever that is called) which is why I am on Prolia. I think that if one is diagnosed as potentially having osteoporosis one can go for a bone density every two years. I have been taking Prolia for two years so I think that I am entitled to another scanning. I have to go to a hospital for an injection of Prolia so that Medicare will pay for it. Again I'm sceptical if anything can really strengthen my bones at my age. I do plank exercises in Yoga and pilates and like to row on a Concep2 at my Health Club. As far as I'm concerned that is all that I can do? Drugs or Calcium and Vitamin D help? I don't know. I doubt it.
Osteopenia.

If that doctor is not a bone specialist or Endocrinologist, I might see if these drugs and treatment are necessary.

Re: Medicare annual physical vs wellness visit

Posted: Tue Mar 19, 2019 12:38 pm
by drawpoker
jkrm wrote: Tue Mar 19, 2019 8:35 am If you have a Medigap plan (I am thinking F or G), wouldn't that pick up the cost of a physical? Or are you still stuck with just an annual wellness visit?
I think you're stuck. Only the ones in certain MA plans are getting the annual physical (with a co-pay, of course, so it's not really free)

Remember, whatever Medigap plan you carry, F or G, that coverage only kicks in after Medicare has officially approved the claim/applied its allowed benefit. Then your supplement picks up the 20% (unless you haven't met your Part B deductible yet if you are on "G". On "F", it doesn't matter, the deductible is already picked up by the insurer.

(I really have no exp. with any of it as I had several serious conditions when first going on Medicare nearly 5 years ago. Thus, all my visits, whether to PCP or specialist, are coded "FU" (follow-up) so the issue has never come up for me. I also carry Plan F, so haven't paid a single medical bill since 2014 :D )

Re: Medicare annual physical vs wellness visit

Posted: Tue Mar 19, 2019 12:44 pm
by drawpoker
Lynette wrote: Tue Mar 19, 2019 10:32 am .... As far as I'm concerned that is all that I can do? Drugs or Calcium and Vitamin D help? I don't know. I doubt it.
Not supposed to discuss specific recommendations for medical treatments here. Sending you a p.m.

Re: Medicare annual physical vs wellness visit

Posted: Tue May 05, 2020 11:50 am
by OnTrack
I know this is an old thread, but my comment seems related. I recently had a "welcome to Medicare" visit. All the charges were "Medicare approved" but there was one charge that apparently I have to pay under the deductible. That charge is for "New patient office or other outpatient visit, typically 20 minutes." The charge was $168.00 and Medicare approved $78.26 with $78.26 deductible. I was a new patient because I had previously been at an HMO and I am now on traditional Medicare.

There was also a charge for "Initial Preventative Physical Examination; Face-To-Face Visit, Services Limited To New Benefic ..." (the rest was cut off) that was charged at $338.00 and Medicare approved $170.61 with $0.00 deductible. I assume this was the "welcome to Medicare" visit.

I was surprised to be charged for a new patient visit in addition to the initial preventative visit. I made very clear when I booked the appointment that I only wanted the welcome to Medicare visit.

Re: Medicare annual physical vs wellness visit

Posted: Tue May 05, 2020 11:57 am
by toofache32
OnTrack wrote: Tue May 05, 2020 11:50 am I know this is an old thread, but my comment seems related. I recently had a "welcome to Medicare" visit. All the charges were "Medicare approved" but there was one charge that apparently I have to pay under the deductible. That charge is for "New patient office or other outpatient visit, typically 20 minutes." The charge was $168.00 and Medicare approved $78.26 with $78.26 deductible. I was a new patient because I had previously been at an HMO and I am now on traditional Medicare.

There was also a charge for "Initial Preventative Physical Examination; Face-To-Face Visit, Services Limited To New Benefic ..." (the rest was cut off) that was charged at $338.00 and Medicare approved $170.61 with $0.00 deductible. I assume this was the "welcome to Medicare" visit.

I was surprised to be charged for a new patient visit in addition to the initial preventative visit. I made very clear when I booked the appointment that I only wanted the welcome to Medicare visit.
Did you ask any questions to your doctor during the visit? Most commonly, patients turn the visit into "hey doc, while I'm here, is this dark spot on my skin ok?" or refill blood pressure medicine, etc. The Welcome to Medicare visit has very defined and limited investigations. You really don't even need a doctor for it, a nurse could do it. Anything else is a separate code.

Re: Medicare annual physical vs wellness visit

Posted: Tue May 05, 2020 12:25 pm
by pshonore
I recently had a CT scan - no charge but the Radiologist did charge a $10 copay. Also saw my cardiologist - $10 copay for visit and a $10 copay for EKG (which was more than the Doc got paid for the EKG) - Medicare advantage plan from former employer. Costco seems to be the cheapest place to get shots.

Re: Medicare annual physical vs wellness visit

Posted: Tue May 05, 2020 12:48 pm
by cs412a
I stopped scheduling the annual wellness visit because every single time I had this type of visit, the billing dept. used the wrong codes, Medicare refused to pay, and I had to contact my doctor so that she could set the billing dept. straight. A waste of her time and mine. :annoyed

I still have to see my primary care doctor once a year to monitor a few chronic conditions and set up my prescriptions, but now I do it just as a straight "office visit, established patient".