Preventive Care and Annual Physical 100% Covered but Charged?

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core4portfolio
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by core4portfolio » Sat Mar 09, 2019 6:56 pm

Recently I have learned that Hospital charge extra if you ask or discuss with anything to your doctor in physical exam stating they are not covered.
I raise the concern to center manager and she waive off that.
Allocation : 80/20 (80% TSM, 20% TBM) | Need to learn fishing sooner

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

Post by InMyDreams » Sat Mar 09, 2019 7:05 pm

toofache32 wrote:
Sat Mar 09, 2019 4:31 pm

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.
My healthcare provider's pt portal provides access to results as soon as they are reported, without being "released" by the ordering provider.

I have seen patients on two different occasions show up to the building where the oncologists have an office, because they had looked up their scan results, and seen that the findings were for cancer. Both times were after hours/weekends, the patients had appointments to follow up on Monday, but, not surprisingly, were freaked out to see the results without a medical professional at their side.

Nonetheless, I want fast access to my results. I usually know before my PCP ;)

Barring using a patient portal, you can go to the Medical Records office of Health Information office, plunk down your ID, sign the form, and get your results.

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

Post by ClevrChico » Sat Mar 09, 2019 7:20 pm

That seems like price gouging, unless the $250 actually covered vaccines/bloodwork and the office staff were confused.

My experience is that if any potential problem is found during a preventive physical, that is billed as a standard office visit on top of the preventative visit. Any follow-up visit from the initial preventative is also an office visit. Not all bloodwork is considered preventative either. I've never walked out of a preventative visit with a $0 bill.

I've never heard of getting such a large bill from seeing normal test results. Here, they'll just drop them in the mail and post it to your online records. As others said, maybe it's time to switch clinics.

Turbo29
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by Turbo29 » Sat Mar 09, 2019 7:45 pm

SimonJester wrote:
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...
My doctor's office is always out of flu shots anyway. They tell me to go to Walgreen's, which I do.

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

Post by toofache32 » Sat Mar 09, 2019 8:10 pm

quantAndHold wrote:
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


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.
I agree. Vote with your feet. I'm just trying to make people understand the employees don't make these business decisions, the employers do.
Last edited by toofache32 on Sat Mar 09, 2019 8:16 pm, edited 2 times in total.

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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 8:14 pm

InMyDreams wrote:
Sat Mar 09, 2019 7:05 pm
My healthcare provider's pt portal provides access to results as soon as they are reported, without being "released" by the ordering provider.
I believe these days in many states you can order blood tests yourself without a doctor's order. Insurance won't cover it, but you can get results.

This may even allow those on HDHP plans to shop around and get a better deal on blood work than just going to a recommended lab, and then visiting a doctor if you want interpretation of any 'abnormal' results. Also may require you to keep records on your results yourself for trends.

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

Post by bayview » Sat Mar 09, 2019 9:26 pm

BogleFanGal wrote:
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
Ask them for a Release of Information form and request the labs. In fact, I’d request labs over the last 3-4 years, since you’re wanting to trend them.

A provider (hospital, physician) owns the physical records, but the patient owns the information in the records. Your doctor’s office is wrong.

I agree that if you want to discuss the results, you should do so on the next visit, or make an appointment.
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri

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

Post by Grasshopper » Sun Mar 10, 2019 7:34 am

Here in Arizona we can have blood workups without a doctors requisition. Plus my lab posts the results of most tests overnight on their website. I still get a message from my doctor about the results no charge.

rich126
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Re: Preventive Care and Annual Physical 100% Covered but Charged?

Post by rich126 » Sun Mar 10, 2019 8:30 am

People have mentioned "gaming" the system. I'm not sure if that is what was going on in my case but it sure seemed like it. A number of years ago I had a medical condition (fortunately only was a scare and nothing serious) where I had to make multiple trips to a urology center (a group of doctors specializing in urology). Every single time I went, the receptionist told me to give a urine sample. Seemingly this was done for every patient.

One time I was in there and an older guy stated in a very loud voice "No, I'm not doing it. You guys are just doing it to make extra money off insurance." I hadn't thought of that before (probably was more concerned with a potential serious medical issue) but I think he was correct.

Now I try to be more careful. If I'm getting some tests at the cardiologist, I don't want them repeated at my primary physician, etc.

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

Post by dm200 » Sun Mar 10, 2019 1:24 pm

rich126 wrote:
Sun Mar 10, 2019 8:30 am
People have mentioned "gaming" the system. I'm not sure if that is what was going on in my case but it sure seemed like it. A number of years ago I had a medical condition (fortunately only was a scare and nothing serious) where I had to make multiple trips to a urology center (a group of doctors specializing in urology). Every single time I went, the receptionist told me to give a urine sample. Seemingly this was done for every patient.
One time I was in there and an older guy stated in a very loud voice "No, I'm not doing it. You guys are just doing it to make extra money off insurance." I hadn't thought of that before (probably was more concerned with a potential serious medical issue) but I think he was correct.
Now I try to be more careful. If I'm getting some tests at the cardiologist, I don't want them repeated at my primary physician, etc.
A few years ago, I learned that when I had an office visit with my Ophthalmologist (following an eye condition that requires such visits every 1-2 years) and I had visual tests done at the same time - there was only one copay. However, if I had those same visual tests done on a different day - I paid the copay twice. I never found this bit of trivia in any health plan documents - but now that I have experienced it - I know what to do and not do for such appointments.

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

Post by Broken Man 1999 » Sun Mar 10, 2019 6:07 pm

dm200 wrote:
Sun Mar 10, 2019 1:24 pm
rich126 wrote:
Sun Mar 10, 2019 8:30 am
People have mentioned "gaming" the system. I'm not sure if that is what was going on in my case but it sure seemed like it. A number of years ago I had a medical condition (fortunately only was a scare and nothing serious) where I had to make multiple trips to a urology center (a group of doctors specializing in urology). Every single time I went, the receptionist told me to give a urine sample. Seemingly this was done for every patient.
One time I was in there and an older guy stated in a very loud voice "No, I'm not doing it. You guys are just doing it to make extra money off insurance." I hadn't thought of that before (probably was more concerned with a potential serious medical issue) but I think he was correct.
Now I try to be more careful. If I'm getting some tests at the cardiologist, I don't want them repeated at my primary physician, etc.
A few years ago, I learned that when I had an office visit with my Ophthalmologist (following an eye condition that requires such visits every 1-2 years) and I had visual tests done at the same time - there was only one copay. However, if I had those same visual tests done on a different day - I paid the copay twice. I never found this bit of trivia in any health plan documents - but now that I have experienced it - I know what to do and not do for such appointments.
When I go to the eye doctor, my eye health checkup is paid by my Humana medical insurance, and my vision test is paid for by Humana vision insurance. Same doctor, same visit. Wife had cataract surgery, and she qualifies for one pair of spectacles on medical insurance, normally the glasses are part of vision insurance.

If one is a person who reads the copious amounts of info that Medicare and insurance companies provide to the insured, following the rules can be beneficial!

I read them and generally I am not surprised when I go to my PCP, pharmacy, ER, lab, specialists, DME provider, etc. Just like when you read the IRS rules and regs, there are Easter eggs to be found by those who read their Medicare and insurance plan documents.

Nobody will look out for your money with as much zeal as yourself. Unless, of course you have so much money it just doesn't matter. So far wife and I do not.

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

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

Post by dm200 » Mon Mar 11, 2019 8:32 am

If one is a person who reads the copious amounts of info that Medicare and insurance companies provide to the insured, following the rules can be beneficial!
I read them and generally I am not surprised when I go to my PCP, pharmacy, ER, lab, specialists, DME provider, etc. Just like when you read the IRS rules and regs, there are Easter eggs to be found by those who read their Medicare and insurance plan documents.
Nobody will look out for your money with as much zeal as yourself. Unless, of course you have so much money it just doesn't matter. So far wife and I do not.
Yes! My wife and I (especially me) actually read and try to understand all this stuff, including my actually reading the inserts for prescription drugs. Over time, I am convinced that we save money every year by knowing such details as well as getting better medical care. win -win.

I am pretty good at reading this kind of things, but it can tend to get confusing. It also helps that I read and try to understand the cases where we are billed. While Kaiser is very good at correct billing, still I have occasionally found errors in my followup. One example is that, under our plan, when you get more than one CT scan at the same appointment (two different parts of the body) you should only be charged for ONE.

In addition, sometimes (in actual practice) we find that we are not billed for things where (according to the fine print) we could or should be.

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

Post by quantAndHold » Mon Mar 11, 2019 7:01 pm

toofache32 wrote:
Sat Mar 09, 2019 8:10 pm
quantAndHold wrote:
Sat Mar 09, 2019 6:50 pm

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.
I agree. Vote with your feet. I'm just trying to make people understand the employees don't make these business decisions, the employers do.
Possibly, but not in my case. The doctor that did this to me was a specialist in the same large corporate medical group as my primary. I saw a bunch of specialists within that group, and had a lot of tests done (was having a problem that they were having trouble diagnosing), but never had anyone else employed in that group try to do that to me. Only this one guy. His nurse could have called me and told me the test was normal and referred me back to my primary. Instead, she called to set up an appointment to get the results, and the first available appointment was over a month away. When I threw a fit, he came on the phone and told me the results were normal.

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