Preventive Care and Annual Physical 100% Covered but Charged?

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edudumb
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Preventive Care and Annual Physical 100% Covered but Charged?

Post by edudumb » Thu Mar 07, 2019 4:13 pm

Here is another question about the healthcare system and how billing works.

Background: I've never been to a physician in the states since moving here a few years ago. I'm with BCBS (high deductible).

I recently wanted to get some CDC-recommended vaccines (100% covered), so I made an appointment with an in-network provider.

When I was there, they said since I was new, I must establish care first. They did the wellness check on me (including blood work and such), and the doc kept asking if I wanted to this test and that test. Not knowing what is covered and what is not, I declined. The doc also said they needed pre-authorization from my BCBS for the vaccines.

A few days later, the doc called and said the blood results came back and vaccines request was approved, and asked me to make a second appointment.

I made the second visit where the doc went through the blood results with me (i.e. "everything is fine, you're healthy"). Strangely, they again said I needed pre-authorization for vaccines again. I had read from Bogleheads about being charged for preventive care, so I had printed a list of preventive care and vaccines that are 100% covered according to ACA/ my insurance benefits. I wanted to make sure the doc wouldn't do anything that isn't covered. The doc took my printed lists and went through it and asked me a bunch of questions (e.g. "do you have depression") and got my blood and urine for STDs (which they didn't do in the 1st visit); not that I had expressed any concerns about STDs though.

Now, the bill came back and I was charged for the 2nd visit for the visit and tests. It was about $250.

I contacted BCBS becos wellness check is 100% covered and STD screenings are also 100% covered. But they said that since the 2nd visit was billed as a medical visit not a routine visit, they won't pick up the bill. They asked me to contact the provider instead.

I contacted the provider, and the admin person said that the 2nd visit was a medical visit because I went in to see the results. But I argued that the doc called me in for checking the results (one line "everything is fine, you're healthy") and for receiving the vaccines (never happened).

The funny thing is that the 1st visit they did the wellness check they said I was 6 ft 1 tall (BMI 19) and the 2nd visit they said I was 5 ft 2 tall (BMI 27). I'm 5 ft 7. The provider is a university medical center, and the physician I saw was a med student. I chose them because I thought they were not for-profit.

So my questions are:
1) Is it really true that annual physical exams are 100% covered but the follow-up to go through the results (upon doc request) is not covered? When the doc called, I was never given another option to go through or receive the results in any other way.

2) The EOB billed for the 2nd visit actually said my visit was for STD tests (not for checking wellness results). But I didn't go in for STD tests. STD tests are just one of the preventive care items. The insurance company states that the visit for preventive care is 100% covered. If true, then how was I charged?

I guess I'm still so confused how the billing works. How was it possible that I had done my research and made sure the doc stayed within the list of preventive care and stuff, and I still got charged for what I thought/ knew should be 100% covered...

123
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by 123 » Thu Mar 07, 2019 4:40 pm

One can be very cautious, undoubtedly you were, and still be surprised by what isn't covered. or how coverage is seemingly manipulated. A "Wellness" visit seems to be designed to generate followup billable events.

From my experience with BCBS, which is basically a fee for services model, there is a tendency to generate a lot more interaction with the patient through multiple exams, referrals, and tests. The more "events" the more billable services I guess. For some vaccinations its cheaper to test for the presence of disease history than to simply give the vaccination (if you're beyond the "normal" age for that vaccination). BCBS is generally a very good health insurance system, but it comes at a cost to the patient.

By contract HMO's do take a more practical approach for a lot of things, it's in their interest to be cost-effective. They'll do a wellness exam and order some tests. They tell you they'll contact you if there's anything amiss. The enhancements in recent years that make lab results available online have done a lot to ease the concern that nobody really looked at the results, since the patient can do that him/herself.
Last edited by 123 on Thu Mar 07, 2019 4:48 pm, edited 1 time in total.
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jacksonm
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by jacksonm » Thu Mar 07, 2019 4:47 pm

Your story is exactly why I stay as far away from the health care system as much as possible and only go to urgent care clinics when I've gotten to the point where I think I need to see a doctor. If I ever get to the point where I'm convinced I might be dealing with something life-threatening like cancer I will obviously seek out more specialized treatment but so far I haven't been there yet. And I'm almost 70.

This basically all started with me when I was talked into getting a colonoscopy by a primary care doctor and ended up having to pay the entire bill because of a fight over whether it was "preventative" or "medically necessary". I eventually got reimbursed but it took a lot of time and effort and I concluded it wasn't worth the effort just to have some test to prove there is nothing wrong with you.

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RickBoglehead
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by RickBoglehead » Thu Mar 07, 2019 4:50 pm

edudumb wrote:
Thu Mar 07, 2019 4:13 pm
Here is another question about the healthcare system and how billing works.

Background: I've never been to a physician in the states since moving here a few years ago. I'm with BCBS (high deductible).

I recently wanted to get some CDC-recommended vaccines (100% covered), so I made an appointment with an in-network provider.

When I was there, they said since I was new, I must establish care first. They did the wellness check on me (including blood work and such), and the doc kept asking if I wanted to this test and that test. Not knowing what is covered and what is not, I declined. The doc also said they needed pre-authorization from my BCBS for the vaccines.

A few days later, the doc called and said the blood results came back and vaccines request was approved, and asked me to make a second appointment.

I made the second visit where the doc went through the blood results with me (i.e. "everything is fine, you're healthy"). Strangely, they again said I needed pre-authorization for vaccines again. I had read from Bogleheads about being charged for preventive care, so I had printed a list of preventive care and vaccines that are 100% covered according to ACA/ my insurance benefits. I wanted to make sure the doc wouldn't do anything that isn't covered. The doc took my printed lists and went through it and asked me a bunch of questions (e.g. "do you have depression") and got my blood and urine for STDs (which they didn't do in the 1st visit); not that I had expressed any concerns about STDs though.

Now, the bill came back and I was charged for the 2nd visit for the visit and tests. It was about $250.

I contacted BCBS becos wellness check is 100% covered and STD screenings are also 100% covered. But they said that since the 2nd visit was billed as a medical visit not a routine visit, they won't pick up the bill. They asked me to contact the provider instead.

I contacted the provider, and the admin person said that the 2nd visit was a medical visit because I went in to see the results. But I argued that the doc called me in for checking the results (one line "everything is fine, you're healthy") and for receiving the vaccines (never happened).

The funny thing is that the 1st visit they did the wellness check they said I was 6 ft 1 tall (BMI 19) and the 2nd visit they said I was 5 ft 2 tall (BMI 27). I'm 5 ft 7. The provider is a university medical center, and the physician I saw was a med student. I chose them because I thought they were not for-profit.

So my questions are:
1) Is it really true that annual physical exams are 100% covered but the follow-up to go through the results (upon doc request) is not covered? When the doc called, I was never given another option to go through or receive the results in any other way.

2) The EOB billed for the 2nd visit actually said my visit was for STD tests (not for checking wellness results). But I didn't go in for STD tests. STD tests are just one of the preventive care items. The insurance company states that the visit for preventive care is 100% covered. If true, then how was I charged?

I guess I'm still so confused how the billing works. How was it possible that I had done my research and made sure the doc stayed within the list of preventive care and stuff, and I still got charged for what I thought/ knew should be 100% covered...


This is the provider playing the system.

Vaccines are covered. Show list, get shot.

Certain blood tests are covered, some are applied to deductible as diagnostic, not preventative.

I had my well visit. Asked for a skin tag to be removed. Dr. said I had to make an appt. Made appt, paid $20. Dr. tries to get me to sign slip for $135 skin tag removal (scissor snip). Nope. He says "I will eat it". He got paid for an office visit...
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quantAndHold
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by quantAndHold » Thu Mar 07, 2019 4:55 pm

Yes, the first visit is the wellness visit. You're only allowed one wellness visit per year, so they're going to charge for the second visit.

Every medical practice I've been to in the past 10 years has an online patient portal. My doctor has always emailed me to tell me the lab results. No need for a second appointment unless there's a problem.

If you have a doctor's order, vaccines can be given by a nurse, without having to see the doc another time. If Costco takes your plan, you can get the shots at Costco, without paying the fee to get the shot. Your regular medical practice will probably charge for that.

beserker
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by beserker » Thu Mar 07, 2019 5:12 pm

Yeah, some doctors like to make more money by having you come back. I left my last doctor because he would make me come back after every visit just to tell me my result was fine then charges me and the insurance for the second visit. Although my copay wasn’t bad, it was far and he was wasting my time. Another doctor made two separate claims for a single visit because I asked for a refill on my maintenance drug and told me that wasn’t part of preventive checkup. Now if you can find a doctor who is so good that he/she does not need to play these games, I would stick with that one.

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BogleFanGal
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by BogleFanGal » Thu Mar 07, 2019 7:27 pm

beserker wrote:
Thu Mar 07, 2019 5:12 pm
Yeah, some doctors like to make more money by having you come back. I left my last doctor because he would make me come back after every visit just to tell me my result was fine then charges me and the insurance for the second visit. Although my copay wasn’t bad, it was far and he was wasting my time. Another doctor made two separate claims for a single visit because I asked for a refill on my maintenance drug and told me that wasn’t part of preventive checkup. Now if you can find a doctor who is so good that he/she does not need to play these games, I would stick with that one.
Yup...this exactly. I learned fast after the first doctor scheduled a followup visit, just to say in 10 seconds "everything is normal". Then I was hit with a $150 bill. (HDHP, so 100% oop until deductible is met.) I wised up. Now every time a physician tells me to schedule a followup after an annual wellness exam, I explain the situation and ask if their team can just leave me a VM if results are normal.

Most aren't trying to get away with anything: I've found many still aren't familiar with how HDHP plans work and think 2nd visit is always covered or at most patient pays $10-20. Once they understand why I'm asking, they've never refused.
"Life would be infinitely happier if we could only be born at the age of eighty and gradually approach eighteen." Mark Twain

pdavi21
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by pdavi21 » Thu Mar 07, 2019 7:40 pm

They shouldn't have charged. Just don't pay. Same thing happened to me, but I told them in advance I wouldn't pay for anything regardless of insurance. Eventually, they wanted to get paid, so they billed the right codes.

EDIT: When I say just don't pay, I mean really also send written notice to the healthcare provider, insurance provider, and file a complaint with your state's insurance regulator.
"We spend a great deal of time studying history, which, let's face it, is mostly the history of stupidity." -Stephen Hawking

mgensler
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by mgensler » Thu Mar 07, 2019 8:47 pm

My doc has me go to the lab a few days before the visit. That way she has the test results to discuss with me during the exam.

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Nate79
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by Nate79 » Thu Mar 07, 2019 9:31 pm

My doctors have always posted the feedback on their online system or by a voicemail. Its absurd in the OPs case. They knew exactly what they were doing. Driving business.

Big Dog
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by Big Dog » Thu Mar 07, 2019 10:25 pm

I've found many still aren't familiar with how HDHP plans work and think 2nd visit is always covered or at most patient pays $10-20.
Uh, no. A physical/preventive at 100% is covered under one visit. A second visit costs $. Office is making more.

(OP could have also asked a local pharmacy for a vaccine. The vaccine would be covered by an ACA plan at 100%, but there is no office visit at the pharmacy.)
1) Is it really true that annual physical exams are 100% covered but the follow-up to go through the results (upon doc request) is not covered?
Yes.
When the doc called, I was never given another option to go through or receive the results in any other way.
Since the tests found nothing, there was no reason for an in office visit.
2) The EOB billed for the 2nd visit actually said my visit was for STD tests (not for checking wellness results). But I didn't go in for STD tests. STD tests are just one of the preventive care items. The insurance company states that the visit for preventive care is 100% covered. If true, then how was I charged?
STD = standard? Or, the 'other' STD?

toofache32
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by toofache32 » Thu Mar 07, 2019 11:00 pm

edudumb wrote:
Thu Mar 07, 2019 4:13 pm

The funny thing is that the 1st visit they did the wellness check they said I was 6 ft 1 tall (BMI 19) and the 2nd visit they said I was 5 ft 2 tall (BMI 27). I'm 5 ft 7. The provider is a university medical center, and the physician I saw was a med student. I chose them because I thought they were not for-profit.
Are you saying you thought everyone there was working out of the goodness of their hearts? What do you think "non-profit" means?

Topic Author
edudumb
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by edudumb » Thu Mar 07, 2019 11:12 pm

Big Dog wrote:
Thu Mar 07, 2019 10:25 pm
I've found many still aren't familiar with how HDHP plans work and think 2nd visit is always covered or at most patient pays $10-20.
Uh, no. A physical/preventive at 100% is covered under one visit. A second visit costs $. Office is making more.

(OP could have also asked a local pharmacy for a vaccine. The vaccine would be covered by an ACA plan at 100%, but there is no office visit at the pharmacy.)
1) Is it really true that annual physical exams are 100% covered but the follow-up to go through the results (upon doc request) is not covered?
Yes.
When the doc called, I was never given another option to go through or receive the results in any other way.
Since the tests found nothing, there was no reason for an in office visit.
2) The EOB billed for the 2nd visit actually said my visit was for STD tests (not for checking wellness results). But I didn't go in for STD tests. STD tests are just one of the preventive care items. The insurance company states that the visit for preventive care is 100% covered. If true, then how was I charged?
STD = standard? Or, the 'other' STD?
"Since the tests found nothing, there was no reason for an in office visit." <-- Yeah, but I wouldn't know until I go in.

STD = Sexually Transmitted Diseases

Topic Author
edudumb
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by edudumb » Thu Mar 07, 2019 11:16 pm

toofache32 wrote:
Thu Mar 07, 2019 11:00 pm
edudumb wrote:
Thu Mar 07, 2019 4:13 pm

The funny thing is that the 1st visit they did the wellness check they said I was 6 ft 1 tall (BMI 19) and the 2nd visit they said I was 5 ft 2 tall (BMI 27). I'm 5 ft 7. The provider is a university medical center, and the physician I saw was a med student. I chose them because I thought they were not for-profit.
Are you saying you thought everyone there was working out of the goodness of their hearts? What do you think "non-profit" means?
:oops:
I just thought the goal of the university medical center was to train medical students. My visits were not taken care of by licensed physician. I was only seen by medical students and residents. When I signed up, I was informed upfront that my visits would be "watched" by medical students for education purposes. Though truth was that the students weren't really watching. I thought they had a much lower cost structure -- medical students weren't paid (if at all) same as licensed physicians, the center located on univ campus serving students as well. (I work at the university next door, and we have a medical center as well, it just isn't in-network.)

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edudumb
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by edudumb » Thu Mar 07, 2019 11:22 pm

pdavi21 wrote:
Thu Mar 07, 2019 7:40 pm
They shouldn't have charged. Just don't pay. Same thing happened to me, but I told them in advance I wouldn't pay for anything regardless of insurance. Eventually, they wanted to get paid, so they billed the right codes.

EDIT: When I say just don't pay, I mean really also send written notice to the healthcare provider, insurance provider, and file a complaint with your state's insurance regulator.
Thanks. I'll do what you suggest, though I feel that the system (insurance and healthcare provider) just don't care. They can bill it anyway they want (preventive or not, it's up to them to say), ppl like us don't know what is really covered, and will just pay the bill.

I thought I played the game right by doing my research. I literally wrote to BCBS formally prior to the visits asking what preventive care would be covered + read the benefits in great details + printed list of items + told doc explicitly to follow the list. I just got surprised. :oops:

Topic Author
edudumb
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by edudumb » Thu Mar 07, 2019 11:24 pm

mgensler wrote:
Thu Mar 07, 2019 8:47 pm
My doc has me go to the lab a few days before the visit. That way she has the test results to discuss with me during the exam.
In my case, I don't get to communicate with doc until I make an appt, and appt costs :dollar :dollar

toofache32
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by toofache32 » Thu Mar 07, 2019 11:37 pm

edudumb wrote:
Thu Mar 07, 2019 11:16 pm
toofache32 wrote:
Thu Mar 07, 2019 11:00 pm
edudumb wrote:
Thu Mar 07, 2019 4:13 pm

The funny thing is that the 1st visit they did the wellness check they said I was 6 ft 1 tall (BMI 19) and the 2nd visit they said I was 5 ft 2 tall (BMI 27). I'm 5 ft 7. The provider is a university medical center, and the physician I saw was a med student. I chose them because I thought they were not for-profit.
Are you saying you thought everyone there was working out of the goodness of their hearts? What do you think "non-profit" means?
:oops:
I just thought the goal of the university medical center was to train medical students. My visits were not taken care of by licensed physician. I was only seen by medical students and residents. When I signed up, I was informed upfront that my visits would be "watched" by medical students for education purposes. Though truth was that the students weren't really watching. I thought they had a much lower cost structure -- medical students weren't paid (if at all) same as licensed physicians, the center located on univ campus serving students as well. (I work at the university next door, and we have a medical center as well, it just isn't in-network.)
Residents ARE licensed physicians. Med students are not. Residents are not students. I have residents working in our clinic. They come find me if there is an issue they cannot handle.

Topic Author
edudumb
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by edudumb » Thu Mar 07, 2019 11:43 pm

toofache32 wrote:
Thu Mar 07, 2019 11:37 pm
edudumb wrote:
Thu Mar 07, 2019 11:16 pm
toofache32 wrote:
Thu Mar 07, 2019 11:00 pm
edudumb wrote:
Thu Mar 07, 2019 4:13 pm

The funny thing is that the 1st visit they did the wellness check they said I was 6 ft 1 tall (BMI 19) and the 2nd visit they said I was 5 ft 2 tall (BMI 27). I'm 5 ft 7. The provider is a university medical center, and the physician I saw was a med student. I chose them because I thought they were not for-profit.
Are you saying you thought everyone there was working out of the goodness of their hearts? What do you think "non-profit" means?
:oops:
I just thought the goal of the university medical center was to train medical students. My visits were not taken care of by licensed physician. I was only seen by medical students and residents. When I signed up, I was informed upfront that my visits would be "watched" by medical students for education purposes. Though truth was that the students weren't really watching. I thought they had a much lower cost structure -- medical students weren't paid (if at all) same as licensed physicians, the center located on univ campus serving students as well. (I work at the university next door, and we have a medical center as well, it just isn't in-network.)
Residents ARE licensed physicians. Med students are not. Residents are not students.
I see; thanks! I said it becos in my BCBS bill, the physician's name listed wasn't the one who saw me. I asked the med center, and the lady said those who saw me were med students and residents, and that they couldn't list themselves as physicians. I clearly don't know how it works. :P

toofache32
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by toofache32 » Thu Mar 07, 2019 11:46 pm

edudumb wrote:
Thu Mar 07, 2019 11:43 pm
toofache32 wrote:
Thu Mar 07, 2019 11:37 pm
edudumb wrote:
Thu Mar 07, 2019 11:16 pm
toofache32 wrote:
Thu Mar 07, 2019 11:00 pm
edudumb wrote:
Thu Mar 07, 2019 4:13 pm

The funny thing is that the 1st visit they did the wellness check they said I was 6 ft 1 tall (BMI 19) and the 2nd visit they said I was 5 ft 2 tall (BMI 27). I'm 5 ft 7. The provider is a university medical center, and the physician I saw was a med student. I chose them because I thought they were not for-profit.
Are you saying you thought everyone there was working out of the goodness of their hearts? What do you think "non-profit" means?
:oops:
I just thought the goal of the university medical center was to train medical students. My visits were not taken care of by licensed physician. I was only seen by medical students and residents. When I signed up, I was informed upfront that my visits would be "watched" by medical students for education purposes. Though truth was that the students weren't really watching. I thought they had a much lower cost structure -- medical students weren't paid (if at all) same as licensed physicians, the center located on univ campus serving students as well. (I work at the university next door, and we have a medical center as well, it just isn't in-network.)
Residents ARE licensed physicians. Med students are not. Residents are not students.
I see; thanks! I said it becos in my BCBS bill, the physician's name listed wasn't the one who saw me. I asked the med center, and the lady said those who saw me were med students and residents, and that they couldn't list themselves as physicians. I clearly don't know how it works. :P
I have a clinic run by residents. They see all the patients and run things by me when needed. My name is on the claim as the billing provider although the residents perform the face to face encounter.

pdavi21
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by pdavi21 » Fri Mar 08, 2019 12:20 am

toofache32 wrote:
Thu Mar 07, 2019 11:35 pm
I'm tired of American Airlines charging me extra fees just for checking luggage. I think I'll have a talk with the pilot about this next time.
Does the pilot sign your luggage receipt?
"We spend a great deal of time studying history, which, let's face it, is mostly the history of stupidity." -Stephen Hawking

toofache32
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by toofache32 » Fri Mar 08, 2019 12:32 am

pdavi21 wrote:
Fri Mar 08, 2019 12:20 am
toofache32 wrote:
Thu Mar 07, 2019 11:35 pm
I'm tired of American Airlines charging me extra fees just for checking luggage. I think I'll have a talk with the pilot about this next time.
Does the pilot sign your luggage receipt?
This thread is about employed physicians. They are like airline pilots....they fly the plane but they do not own it and have no say in how much your tickets cost. People are blaming the physician who does not make these policies.
Last edited by toofache32 on Fri Mar 08, 2019 2:06 am, edited 1 time in total.

Erwin007
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by Erwin007 » Fri Mar 08, 2019 12:58 am

I think that this is more of a phenomenon in primary care than it is with surgeons or proceduralists. I get paid more when I do a surgery than when I see someone in clinic, so it behooves me to only see patients who need surgery. Primary care docs seem to want to “churn the accounts” in order to generate more office visits since that is how they are paid. For some things, this is clearly necessary. If you are initiating a treatment or medication, or going over some type of critical lab, that should be done in a formal office visit. You can’t just start someone on a medication or treatment and not have some sort of follow up to assess how things are progressing (or not).

This issue cuts both ways though. I had several patients complain (including online—don’t get me started on that) when I had my medical assistant call them to tell them their labs, or MRI, or nerve study was normal (meaning they didn’t need anything surgical done). They didn’t have to pay a co-pay and I didn’t fill up one of my valuable clinic slots with someone who 1) wasn’t going to need surgery, and 2) probably should have been seen and worked up by a non-specialist prior to them even seeing me. But for some, that wasn’t good enough or wasn’t what they wanted. I just felt like it was an efficient use of everyone’s time and valuable healthcare resources to avoid a visit where I told someone everything was normal and they could try any number of conservative treatments I had discussed with them at their original office visit.

JPM
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by JPM » Fri Mar 08, 2019 2:13 pm

Sounds like OP attended a training clinic at a teaching hospital or clinic. Staffed by trainee residents and supervised by a training doctor. The residents probably receive little or no training in billing and coding beyond being able to distinguish levels of service. Unlikely they know or understand the billing distinction between preventive services and diagnostic services when ordering tests. Their clinic probably deals with hundreds of insurance plans and each plan is free to designate what it will or will not cover for free as preventive services and what it will cover only with deductible and copay as a diagnostic service. They are not all alike in this regard except for mandated services like mammograms. Some things that seem logically to be preventive, like STD testing, may be considered preventive by some plans and can thus be billed under a preventive service code and be 100% covered, and other plans may regard them as diagnostic tests and will be covered minus deductible and copay and only when billed under a diagnostic service code.

In a training clinic the trainees are trained to and expected to followup on test results whether normal or not. Since OP is not an established patient at the clinic, the usual practice is to schedule a followup appointment at the close of the initial visit so the trainee will be able to followup on the tests. Established patients may be notified of results and recommendations by phone or email but new patients not usually. As to financial incentives, both the resident trainee and the clinic supervisor/trainer are on salary and not paid on volume in any training clinic I am aware of. When I decide to be a patient in a training hospital or clinic, I will often be dealing with inexperienced people and I expect that I may have to coach the trainee and may have to appeal to the supervising doctor if things don't go well with the trainee.

megabad
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by megabad » Fri Mar 08, 2019 2:28 pm

edudumb wrote:
Thu Mar 07, 2019 4:13 pm
1) Is it really true that annual physical exams are 100% covered but the follow-up to go through the results (upon doc request) is not covered? When the doc called, I was never given another option to go through or receive the results in any other way.
Yes, this is how it usually works in my experience.

2) The EOB billed for the 2nd visit actually said my visit was for STD tests (not for checking wellness results). But I didn't go in for STD tests. STD tests are just one of the preventive care items. The insurance company states that the visit for preventive care is 100% covered. If true, then how was I charged?
Some policies cover these types of tests and some don't so it depends on your policy. If covered, you would not see a doctor for this. With my PCP, if you see a doctor, that is not a test, it is a doctor's visit.

In general, your outcome seems totally normal to me though I am not praising how the medical system works. Next time, if a doctor visit isn't required, I wouldn't see one. Non mandatory vaccines can generally be easily provided at a clinic.

bryansmile
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by bryansmile » Fri Mar 08, 2019 3:21 pm

OP, you are still lucky. When I took my son to see his doctor who then ordered an x-ray at the medical center next door (in network), besides all the charges for dr's visit and x-ray, the medical center also billed me a $350 "facility charge", for using their x-ray facility. I called and was told this charged will not go away except if my household income is below $120k - this is a very low threshold in the northeast region, and for which we don't qualify.

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cheese_breath
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by cheese_breath » Fri Mar 08, 2019 3:53 pm

jacksonm wrote:
Thu Mar 07, 2019 4:47 pm
... I concluded it wasn't worth the effort just to have some test to prove there is nothing wrong with you.
Would you have been happier if it proved you had advanced colon cancer? Your body is like a car. Every so often you should check the tire pressure, gas gage, oil dip stick just to prove they're all OK. But you can't get a new body as cheaply as you can get a new car.
The surest way to know the future is when it becomes the past.

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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by toofache32 » Fri Mar 08, 2019 4:19 pm

bryansmile wrote:
Fri Mar 08, 2019 3:21 pm
OP, you are still lucky. When I took my son to see his doctor who then ordered an x-ray at the medical center next door (in network), besides all the charges for dr's visit and x-ray, the medical center also billed me a $350 "facility charge", for using their x-ray facility. I called and was told this charged will not go away except if my household income is below $120k - this is a very low threshold in the northeast region, and for which we don't qualify.
Facility fees are one reason why healthcare is getting so much more expensive. The facilities are buying up medical practices so they can charge these additional fees for the same services you can often get in a private doctors office.

jacksonm
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by jacksonm » Fri Mar 08, 2019 4:47 pm

cheese_breath wrote:
Fri Mar 08, 2019 3:53 pm
jacksonm wrote:
Thu Mar 07, 2019 4:47 pm
... I concluded it wasn't worth the effort just to have some test to prove there is nothing wrong with you.
Would you have been happier if it proved you had advanced colon cancer? Your body is like a car. Every so often you should check the tire pressure, gas gage, oil dip stick just to prove they're all OK. But you can't get a new body as cheaply as you can get a new car.
No, of course I would not have been happy to find out I had advanced colon cancer. I would have been very surprised however, since I had no symptoms and there is no history of colon cancer in my family. The only reason I had the procedure was because doctors kept insisting on it.

The effectiveness of cancer screening is something that a lot of people assume but studies don't bear it out so well. Take the PSA test for prostrate cancer in men and breast cancer screening in women. Guidelines on both of these procedures have changed and they are no longer recommended to the extent they once were. The reason is because there are too many false positives and too much over-treatment based on the results.

So I choose to make an informed decision about these things for myself.

cwied
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by cwied » Fri Mar 08, 2019 5:06 pm

jacksonm wrote:
Fri Mar 08, 2019 4:47 pm

No, of course I would not have been happy to find out I had advanced colon cancer. I would have been very surprised however, since I had no symptoms and there is no history of colon cancer in my family. The only reason I had the procedure was because doctors kept insisting on it.
Most people who are diagnosed with colon cancer are very surprised. The problem with low-probability events is that they still happen to someone. You'd rather catch colon cancer before you have symptoms than at a later stage.

I definitely think it's a good idea to be informed, but don't forego your covered care just to spite the system. The system won't care and you just miss out on more data that you can use for your decision making.

The current system is broken in many ways, but it is the only one we have right now (unless you're rich enough to pay for concierge health care). I think we just have to put up with the extra hassle and hope that change will come over time.

jacksonm
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by jacksonm » Fri Mar 08, 2019 6:46 pm

cwied wrote:
Fri Mar 08, 2019 5:06 pm
jacksonm wrote:
Fri Mar 08, 2019 4:47 pm

No, of course I would not have been happy to find out I had advanced colon cancer. I would have been very surprised however, since I had no symptoms and there is no history of colon cancer in my family. The only reason I had the procedure was because doctors kept insisting on it.
I definitely think it's a good idea to be informed, but don't forego your covered care just to spite the system. The system won't care and you just miss out on more data that you can use for your decision making.
Thanks. I'll keep that in mind whenever it feels like I might be making irrational choices about my health just to spite the system.

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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by stefan_lec » Sat Mar 09, 2019 12:31 am

I would highly recommend checking to see if there's a Direct Primary Care (DPC) practice in your area. I signed up with a DPC doctor about 4 months ago, and they've been amazing. I pay them a flat $50 / month fee, and they don't accept or bill insurance at all. Office visits are completely free, so they have no motivation to get you back in the office for second or third visits (in fact, if they can resolve the problem over phone or email, they will). In-office procedures are provided for free or very cheap, and they usually have low negotiated rates for external services like blood work, MRI's, etc.

For example, my DPC physician only charged me $35 for a blood panel on my initial visit. When a skin tag on my neck became inflamed, I emailed my doctor a picture, she responded within two hours on a Sunday to tell me it looked benign, and I was able to get an appointment with her to have it removed that Wednesday. The total cost to remove the tag was only $15. They dispense wholesale medication in-house, so a 90-day supply of my blood pressure and cholesterol medications cost $13 total. They also have negotiated extremely cheap rates for various diagnostic tests with providers in town - an MRI only costs $250, for example.

Note that a DPC practice is different than concierge care - concierge care bills insurance and is quite expensive, while DPC is cheaper and is intended to serve people who have high-deductible health insurance and don't bill their insurance for everyday medical expenses. The concept is new enough that many people who report on it in the media (like Clark Howard) still use the terms interchangeably, but they are two very different things.

For more details on how this works, this whitepaper (submitted to the US Senate Nov 2018) is excellent:
https://www.help.senate.gov/imo/media/doc/Gross2.pdf

To find a DPC practice, I recommend this site:
https://www.mydpc.org/dpc-directory

You should also try searching for "direct primary care <city> <state>" on Google, since a lot of DPC practices are very new, and they might not have made it onto the directory yet.

SimonJester
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by SimonJester » Sat Mar 09, 2019 12:17 pm

toofache32 wrote:
Fri Mar 08, 2019 12:32 am
pdavi21 wrote:
Fri Mar 08, 2019 12:20 am
toofache32 wrote:
Thu Mar 07, 2019 11:35 pm
I'm tired of American Airlines charging me extra fees just for checking luggage. I think I'll have a talk with the pilot about this next time.
Does the pilot sign your luggage receipt?
This thread is about employed physicians. They are like airline pilots....they fly the plane but they do not own it and have no say in how much your tickets cost. People are blaming the physician who does not make these policies.
But the pilot doesn't tell me to buy another airplane ticket to retrieve my luggage. I get the whole physician is now an employee but when the test
results are 100% normal I think the physician owes some fiduciary duty to the patient to perhaps just provide a phone call.
Does the physician not have this discretion anymore? I really want my health care decisions to be a corporation between my physician and myself...

Time for healthcare 3.0...
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

toofache32
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by toofache32 » Sat Mar 09, 2019 12:28 pm

SimonJester wrote:
Sat Mar 09, 2019 12:17 pm
toofache32 wrote:
Fri Mar 08, 2019 12:32 am
pdavi21 wrote:
Fri Mar 08, 2019 12:20 am
toofache32 wrote:
Thu Mar 07, 2019 11:35 pm
I'm tired of American Airlines charging me extra fees just for checking luggage. I think I'll have a talk with the pilot about this next time.
Does the pilot sign your luggage receipt?
This thread is about employed physicians. They are like airline pilots....they fly the plane but they do not own it and have no say in how much your tickets cost. People are blaming the physician who does not make these policies.
But the pilot doesn't tell me to buy another airplane ticket to retrieve my luggage. I get the whole physician is now an employee but when the test
results are 100% normal I think the physician owes some fiduciary duty to the patient to perhaps just provide a phone call.
Does the physician not have this discretion anymore? I really want my health care decisions to be a corporation between my physician and myself...

Time for healthcare 3.0...
The physician has this discretion, but like most people, would rather be doing things he/she is getting paid to do like seeing more patients. Some practices have a nurse or someone call back when results are normal. For abnormal results, this generally needs a new visit to plan a treatment to address the abnormal results. With so many tests/labs being ordered in a primary care office, it would take an entire day out of the week to personally call back all those patients with results and answer their questions.

The pilot does not tell you to buy another ticket to retrieve your luggage....the airline tells you that.

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SlowMovingInvestor
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by SlowMovingInvestor » Sat Mar 09, 2019 12:43 pm

toofache32 wrote:
Thu Mar 07, 2019 11:00 pm
edudumb wrote:
Thu Mar 07, 2019 4:13 pm

The funny thing is that the 1st visit they did the wellness check they said I was 6 ft 1 tall (BMI 19) and the 2nd visit they said I was 5 ft 2 tall (BMI 27). I'm 5 ft 7. The provider is a university medical center, and the physician I saw was a med student. I chose them because I thought they were not for-profit.
Are you saying you thought everyone there was working out of the goodness of their hearts? What do you think "non-profit" means?
I don't assume people working at Vanguard (which is essentially non profit) to work out of the goodness of their hearts, and I don't think the OP assumed that for this center either. He did assume they wouldn't ask him to come in for a visit without good reason, and that was definitely naive on his part. He did say he was new to the US, so that is excusable.

I wouldn't blame the resident, but I would certainly blame his/her supervisor if something similar had happened to me. I can understand that physicians don't want to give away freebies, but simply saying or asking someone to say that everything is fine is not a freebie and shouldn't require a visit.

ADDED: I've heard comments about BC/BS in this thread. I'd just like to point out that there are LOTs of different BC/BS companies, with very different policies -- some are even nonprofits.

SimonJester
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by SimonJester » Sat Mar 09, 2019 3:52 pm

toofache32 wrote:
Sat Mar 09, 2019 12:28 pm
The physician has this discretion, but like most people, would rather be doing things he/she is getting paid to do like seeing more patients. Some practices have a nurse or someone call back when results are normal. For abnormal results, this generally needs a new visit to plan a treatment to address the abnormal results. With so many tests/labs being ordered in a primary care office, it would take an entire day out of the week to personally call back all those patients with results and answer their questions.

The pilot does not tell you to buy another ticket to retrieve your luggage....the airline tells you that.


Such a good point, always good to see things from other other side! I like that my DR office allows me to see my test results online. This is good and bad because I play DR google with them...

One thing I have done is get your blood work completed two weeks before your annual visit (may not be possible with first visit). That way you can discuss the results with your DR during your annual visit.

Another insurance trap to watch out for, annual blood work is covered under the annual exam until you then have a condition you are treating. Now your annual blood work becomes part of the treatment of your condition and thus is not covered as preventative care.

Sometimes I wonder if my insurance company uses a magic eight ball to determine if they will pay... ...Outlook not so good...
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

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BogleFanGal
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by BogleFanGal » Sat Mar 09, 2019 4:17 pm

SimonJester wrote:
Sat Mar 09, 2019 3:52 pm
I like that my DR office allows me to see my test results online. This is good and bad because I play DR google with them...
I'd love to be able to see results online: my PCP simply has her office staff leave me a VM if results are "normal" or not. But I'd like to know actual numbers. When you do those wellness bloodwork tests thru insurance, you get reports that show you exact numbers vs previous year.

Am I creeping closer to borderline? Is the blood suger a little higher? Are the good cholesteral numbers a little less good? It's easier to take proactive action if you track trends early on. I've asked for this, but just hear things like "no you're not close to borderline". It's pulling teeth to get them to share numbers unless I pay $150 for a followup visit.
"Life would be infinitely happier if we could only be born at the age of eighty and gradually approach eighteen." Mark Twain

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dm200
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by dm200 » Sat Mar 09, 2019 4:23 pm

On our Kaiser Medicare plan, the actual written policy is the same - you will be charged if you bring up new issues, etc.

However, in actual practice over the last eight years, I have commonly brought up new issues with my PCP - and have never been charged a copay for the office visit. In 2019, the copay for PCP office visit went down to $10 from the previous $20. :happy

toofache32
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by toofache32 » Sat Mar 09, 2019 4:31 pm

BogleFanGal wrote:
Sat Mar 09, 2019 4:17 pm
SimonJester wrote:
Sat Mar 09, 2019 3:52 pm
I like that my DR office allows me to see my test results online. This is good and bad because I play DR google with them...
I'd love to be able to see results online.....

It's pulling teeth to get them to share numbers unless I pay $150 for a followup visit.
The online results are actually a big problem in many practices. Now the doctors have to field phone calls from patients asking why their BUN is too low and why the doctor is not addressing their low BUN.

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SlowMovingInvestor
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by SlowMovingInvestor » Sat Mar 09, 2019 4:33 pm

BogleFanGal wrote:
Sat Mar 09, 2019 4:17 pm
I'd love to be able to see results online: my PCP simply has her office staff leave me a VM if results are "normal" or not. But I'd like to know actual numbers. When you do those wellness bloodwork tests thru insurance, you get reports that show you exact numbers vs previous year.

Am I creeping closer to borderline? Is the blood suger a little higher? Are the good cholesteral numbers a little less good? It's easier to take proactive action if you track trends early on. I've asked for this, but just hear things like "no you're not close to borderline". It's pulling teeth to get them to share numbers unless I pay $150 for a followup visit.

Really ? They don't even send you a printed copy of results if you ask for them ? You (or your insurance) have paid for the tests, you should most definitely get the results. In fact, I thought it was a Federal law that you could ask for your medical records.

Now if you want an interpretation of those results, it's reasonable to ask you to make a visit.

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BogleFanGal
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by BogleFanGal » Sat Mar 09, 2019 4:48 pm

toofache32 wrote:
Sat Mar 09, 2019 4:31 pm
BogleFanGal wrote:
Sat Mar 09, 2019 4:17 pm
SimonJester wrote:
Sat Mar 09, 2019 3:52 pm
I like that my DR office allows me to see my test results online. This is good and bad because I play DR google with them...
I'd love to be able to see results online.....

It's pulling teeth to get them to share numbers unless I pay $150 for a followup visit.
The online results are actually a big problem in many practices. Now the doctors have to field phone calls from patients asking why their BUN is too low and why the doctor is not addressing their low BUN.
I can certainly understand your issue there. I'd never call the office with questions like that: I'd cough up the office visit fee and schedule another visit. I want the numbers for myself though.
"Life would be infinitely happier if we could only be born at the age of eighty and gradually approach eighteen." Mark Twain

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BogleFanGal
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by BogleFanGal » Sat Mar 09, 2019 4:50 pm

SlowMovingInvestor wrote:
Sat Mar 09, 2019 4:33 pm
BogleFanGal wrote:
Sat Mar 09, 2019 4:17 pm
I'd love to be able to see results online: my PCP simply has her office staff leave me a VM if results are "normal" or not. But I'd like to know actual numbers. When you do those wellness bloodwork tests thru insurance, you get reports that show you exact numbers vs previous year.

Am I creeping closer to borderline? Is the blood suger a little higher? Are the good cholesteral numbers a little less good? It's easier to take proactive action if you track trends early on. I've asked for this, but just hear things like "no you're not close to borderline". It's pulling teeth to get them to share numbers unless I pay $150 for a followup visit.

Really ? They don't even send you a printed copy of results if you ask for them ? You (or your insurance) have paid for the tests, you should most definitely get the results. In fact, I thought it was a Federal law that you could ask for your medical records.

Now if you want an interpretation of those results, it's reasonable to ask you to make a visit.
Agreed - I just want the numbers, since I like to do a year over year comparison. The office staff seemed very resistant to it, but I'm going to ask them again this year. When I do mammos and other imaging tests, I can have a copy of the results sent to me and my doc. But somehow, bloodwork doesn't work that way :annoyed
"Life would be infinitely happier if we could only be born at the age of eighty and gradually approach eighteen." Mark Twain

Dottie57
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by Dottie57 » Sat Mar 09, 2019 4:53 pm

My medical test results are online. Check for that type of service (free).

Erwin007
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by Erwin007 » Sat Mar 09, 2019 5:11 pm

toofache32 wrote:
Sat Mar 09, 2019 4:31 pm
BogleFanGal wrote:
Sat Mar 09, 2019 4:17 pm
SimonJester wrote:
Sat Mar 09, 2019 3:52 pm
I like that my DR office allows me to see my test results online. This is good and bad because I play DR google with them...
I'd love to be able to see results online.....

It's pulling teeth to get them to share numbers unless I pay $150 for a followup visit.
The online results are actually a big problem in many practices. Now the doctors have to field phone calls from patients asking why their BUN is too low and why the doctor is not addressing their low BUN.
Just need to increase BUN in the diet, no? :oops:

Imaging tests, particularly things like MRIs are way worse. So many incidental findings on those that have no relation whatsoever to their presenting complaint. Patients can’t believe you’re ignoring things (sprain of this, tear of that, etc) that have no clinical significance. I’m all for patients having their information, but if someone wants me to explain why I’m ignoring their “early cartilage wear” in their thumb basilar joint when they came in for a suspected TFCC tear, I’m not having that conversation over the phone and not being paid for it.

A little knowledge can be a very dangerous thing in the wrong (uneducated) hands...

SpideyIndexer
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by SpideyIndexer » Sat Mar 09, 2019 5:13 pm

it is very frustrating the way medical businesses extract money from a patient with little visibility. Here's an example. I made an appointment to see an ENT in the afternoon due to a suspected ear wax problem. The morning of the same day, I went in for an annual physical with my PCP. The doctor asked to look at my ear while I was there. I told him, ok, but that I will be going to the specialist in several hours. He put the scope into my ear and said "Yep, there's a lot of wax there," which took about 1 minute. Imagine my surprise when I saw the bill for an additional $150 procedure. I even called my insurance company BCBS who told me their hands were tied. It still burns me up a couple of years later; the doctor gave me no warning that additional charges would be incurred. Why would he expect that anyone would approve that?

I'm sure most of us have horror stories about trying to get straight answers about how much certain procedures will cost.

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edudumb
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by edudumb » Sat Mar 09, 2019 5:22 pm

SimonJester wrote:
Sat Mar 09, 2019 3:52 pm
toofache32 wrote:
Sat Mar 09, 2019 12:28 pm
The physician has this discretion, but like most people, would rather be doing things he/she is getting paid to do like seeing more patients. Some practices have a nurse or someone call back when results are normal. For abnormal results, this generally needs a new visit to plan a treatment to address the abnormal results. With so many tests/labs being ordered in a primary care office, it would take an entire day out of the week to personally call back all those patients with results and answer their questions.

The pilot does not tell you to buy another ticket to retrieve your luggage....the airline tells you that.


Such a good point, always good to see things from other other side! I like that my DR office allows me to see my test results online. This is good and bad because I play DR google with them...

One thing I have done is get your blood work completed two weeks before your annual visit (may not be possible with first visit). That way you can discuss the results with your DR during your annual visit.

Another insurance trap to watch out for, annual blood work is covered under the annual exam until you then have a condition you are treating. Now your annual blood work becomes part of the treatment of your condition and thus is not covered as preventative care.

Sometimes I wonder if my insurance company uses a magic eight ball to determine if they will pay... ...Outlook not so good...
How does one get blood work done before the visit?

I check the in-network lab (also the same lab that my PCP uses), they need doc's referral. On top of that, I thought that they always say you don't do anything until you see the doc cos doc is the one who decides what tests to do on you. :confused

Erwin007
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by Erwin007 » Sat Mar 09, 2019 5:47 pm

edudumb wrote:
Sat Mar 09, 2019 5:22 pm
SimonJester wrote:
Sat Mar 09, 2019 3:52 pm
toofache32 wrote:
Sat Mar 09, 2019 12:28 pm
The physician has this discretion, but like most people, would rather be doing things he/she is getting paid to do like seeing more patients. Some practices have a nurse or someone call back when results are normal. For abnormal results, this generally needs a new visit to plan a treatment to address the abnormal results. With so many tests/labs being ordered in a primary care office, it would take an entire day out of the week to personally call back all those patients with results and answer their questions.

The pilot does not tell you to buy another ticket to retrieve your luggage....the airline tells you that.


Such a good point, always good to see things from other other side! I like that my DR office allows me to see my test results online. This is good and bad because I play DR google with them...

One thing I have done is get your blood work completed two weeks before your annual visit (may not be possible with first visit). That way you can discuss the results with your DR during your annual visit.

Another insurance trap to watch out for, annual blood work is covered under the annual exam until you then have a condition you are treating. Now your annual blood work becomes part of the treatment of your condition and thus is not covered as preventative care.

Sometimes I wonder if my insurance company uses a magic eight ball to determine if they will pay... ...Outlook not so good...
How does one get blood work done before the visit?

I check the in-network lab (also the same lab that my PCP uses), they need doc's referral. On top of that, I thought that they always say you don't do anything until you see the doc cos doc is the one who decides what tests to do on you. :confused
If you get the same tests done every year (CBC, BMP/Chem 7, thyroid panel, cholesterol panel, whatever), just call in a couple of weeks before your scheduled appointment and ask your doctor’s office to fax/send the orders to your lab (the one that you have checked beforehand is in your network) so you can get them done before your appointment. The other crucial part about this, which many patients neglect, is to do it in a timely fashion so the lab has enough time to send the results back to your doctor so they have them for your apppintment. Going to the lab the day beforehand won’t do you any good because in all likelihood the labs won’t be done or your doctor won’t have them, thus negating the advantage of doing the labs early.

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ejvyas
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by ejvyas » Sat Mar 09, 2019 5:55 pm

In the hindsight if you only wanted vaccines you should have gone to something like minute clinic.

Only one wellness visit is covered per year. Also, if you have some issue Eg. Low platelets or vit d, some blood work may be coded as diagnostic and you may get a bill for it (even if it's screening) . It totally depends on the billing person at the doctor's office. They shouldn't have called you in for a second visit to go over results. It's usually done online or through phone for free.

SimonJester
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by SimonJester » Sat Mar 09, 2019 6:15 pm

Another option for just routine vaccines could be your local pharmacist. I choose this route for my annual flu shot vs making an appointment with my DR which would cost my an office visit...
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

Broken Man 1999
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by Broken Man 1999 » Sat Mar 09, 2019 6:42 pm

Wife and I got our flu shots at Publix Supermarkets and each of us received a $10 gift card. My Humana Medicare Advantage PPO plan pays for immunizations 100%.

As well, for blood work we sometimes use Quest and use their portal for results. On the bloodwork drawn at my doctor's office, the staff will give me a copy if I ask for one.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

quantAndHold
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by quantAndHold » Sat Mar 09, 2019 6:50 pm

toofache32 wrote:
Sat Mar 09, 2019 12:28 pm
SimonJester wrote:
Sat Mar 09, 2019 12:17 pm
toofache32 wrote:
Fri Mar 08, 2019 12:32 am
pdavi21 wrote:
Fri Mar 08, 2019 12:20 am
toofache32 wrote:
Thu Mar 07, 2019 11:35 pm
I'm tired of American Airlines charging me extra fees just for checking luggage. I think I'll have a talk with the pilot about this next time.
Does the pilot sign your luggage receipt?
This thread is about employed physicians. They are like airline pilots....they fly the plane but they do not own it and have no say in how much your tickets cost. People are blaming the physician who does not make these policies.
But the pilot doesn't tell me to buy another airplane ticket to retrieve my luggage. I get the whole physician is now an employee but when the test
results are 100% normal I think the physician owes some fiduciary duty to the patient to perhaps just provide a phone call.
Does the physician not have this discretion anymore? I really want my health care decisions to be a corporation between my physician and myself...

Time for healthcare 3.0...
The physician has this discretion, but like most people, would rather be doing things he/she is getting paid to do like seeing more patients. Some practices have a nurse or someone call back when results are normal. For abnormal results, this generally needs a new visit to plan a treatment to address the abnormal results. With so many tests/labs being ordered in a primary care office, it would take an entire day out of the week to personally call back all those patients with results and answer their questions.

The pilot does not tell you to buy another ticket to retrieve your luggage....the airline tells you that.
If my doctor made me take time off of work and pay for an office visit in order to get normal, unactionable test results, that would be the end of my relationship with them. There are plenty of other doctors that respect my time and money. I don’t need to deal with one that doesn’t.

The one doctor I did see that did that to me is indeed not my doctor anymore. I see someone else in the medical group down the street.

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