Doctors visit/ included physicals

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Topic Author
loveeatingpizza
Posts: 84
Joined: Mon Jan 13, 2020 9:41 pm

Doctors visit/ included physicals

Post by loveeatingpizza »

We are going to a new pediatrician's office in California for my healthy child (other pediatrician is no longer practicing).

They have to schedule a "new patient visit". I've asked their staff if that is the same as the once-a-year free annual well kid visit, which is what I want. We have a high deductible plan which allows for 1 free physical. Unfortunately, I asked the medical staff and they tell me to ask the billing dept, which I did, and vice versa but both could not give me an answer. I don't plan on bringing up any medical issues as my child is quite healthy.

So I am not sure if I am going to be charged for a "new patient visit" along with the "well child visit". Should I just cancel the appt and find a new pediatrician? Not sure what the standard is to charge for both a "new patient visit" and the "well child visit".
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JoeRetire
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Re: Doctors visit/ included physicals

Post by JoeRetire »

loveeatingpizza wrote: Sun Aug 01, 2021 8:09 pm So I am not sure if I am going to be charged for a "new patient visit" along with the "well child visit". Should I just cancel the appt and find a new pediatrician? Not sure what the standard is to charge for both a "new patient visit" and the "well child visit".
Call your insurance company and ask them.
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runner3081
Posts: 5993
Joined: Mon Aug 22, 2016 3:22 pm

Re: Doctors visit/ included physicals

Post by runner3081 »

loveeatingpizza wrote: Sun Aug 01, 2021 8:09 pm We are going to a new pediatrician's office in California for my healthy child (other pediatrician is no longer practicing).

They have to schedule a "new patient visit". I've asked their staff if that is the same as the once-a-year free annual well kid visit, which is what I want. We have a high deductible plan which allows for 1 free physical. Unfortunately, I asked the medical staff and they tell me to ask the billing dept, which I did, and vice versa but both could not give me an answer. I don't plan on bringing up any medical issues as my child is quite healthy.

So I am not sure if I am going to be charged for a "new patient visit" along with the "well child visit". Should I just cancel the appt and find a new pediatrician? Not sure what the standard is to charge for both a "new patient visit" and the "well child visit".
I work in healthcare and this is a new, (in my opinion) ridiculous money grab that I ran into when looking for a primary care doctor. They essentially schedule two visits, the new patient visit, which is more social, and then the annual exam. This way, the annual exam is, in theory, free, unless they find an issue, but that bill for that new patient visit and in my case, with HDHP, had to pay out of pocket for it.
Topic Author
loveeatingpizza
Posts: 84
Joined: Mon Jan 13, 2020 9:41 pm

Re: Doctors visit/ included physicals

Post by loveeatingpizza »

runner3081 wrote: Sun Aug 01, 2021 10:01 pm
loveeatingpizza wrote: Sun Aug 01, 2021 8:09 pm We are going to a new pediatrician's office in California for my healthy child (other pediatrician is no longer practicing).

They have to schedule a "new patient visit". I've asked their staff if that is the same as the once-a-year free annual well kid visit, which is what I want. We have a high deductible plan which allows for 1 free physical. Unfortunately, I asked the medical staff and they tell me to ask the billing dept, which I did, and vice versa but both could not give me an answer. I don't plan on bringing up any medical issues as my child is quite healthy.

So I am not sure if I am going to be charged for a "new patient visit" along with the "well child visit". Should I just cancel the appt and find a new pediatrician? Not sure what the standard is to charge for both a "new patient visit" and the "well child visit".
I work in healthcare and this is a new, (in my opinion) ridiculous money grab that I ran into when looking for a primary care doctor. They essentially schedule two visits, the new patient visit, which is more social, and then the annual exam. This way, the annual exam is, in theory, free, unless they find an issue, but that bill for that new patient visit and in my case, with HDHP, had to pay out of pocket for it.
Did it happen to you? Thanks - so it seems like I will be billed out of pocket then. I live in a hcol state so its quite expensive. Either that or find a new pediatrician or change insurance next time.
fundtalk
Posts: 334
Joined: Tue Jun 05, 2007 3:52 pm

Re: Doctors visit/ included physicals

Post by fundtalk »

It sounds like your child is a new patient to the practice, but only needing to be seen for a preventive care visit. There are two separate codes for preventive care visits, one for established patients in the practice and one for new patients. This visit should be coded as a new patient/preventive care visit which is all done in a single visit and with a single code which should be covered as the annual preventive care visit. There are several different codes for this depending on the child’s age.
nalor511
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Re: Doctors visit/ included physicals

Post by nalor511 »

I would not go to this office. When you book appointment must be very careful to use the word "preventative"
rtt22
Posts: 196
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Re: Doctors visit/ included physicals

Post by rtt22 »

DW went for an annual physical checkup, got asked a general question "how are you doing, anything issue", so she talked about stress and a bit of insomnia, did not get a prescription for anything besides a recommendation for over the counter sleeping pills. She got two bills, one for the no-charge annual physical and the other as a normal visit with deductible. This "creative" billing method had not happened in all the previous years she went to this doctor's office. She talked to her insurance company and they did not care one bit, saying they always go by what is coded by the doctor's office. She complained to the doctor's office manager and after much back and forth, the deductible was waived. She switched to another doctor in the same (big) medical group the following year and since then has not been charged for the extra "normal visit" when she went in for the annual physical.
katnok
Posts: 217
Joined: Fri Nov 11, 2011 7:36 pm

Re: Doctors visit/ included physicals

Post by katnok »

I’m a pediatrician. When I see a new patient for a well child check (WCC), unless there are acute health problems (abdo pain, knee pain etc), the visit is charged as a preventative visit, which should be fully covered by your insurance.

Those who think it’s a money grab have no idea how often many of us steer patients away from unnecessary testing/medications etc. On top of that, there’s plenty of unpaid time spent on forms for sports, school forms, medication administration forms, dealing with insurance etc. As a reminder, pediatricians are the lowest paid among ALL medical specialties.
Topic Author
loveeatingpizza
Posts: 84
Joined: Mon Jan 13, 2020 9:41 pm

Re: Doctors visit/ included physicals

Post by loveeatingpizza »

OP here, I called again and kids and adults have different policies:

1. The upcoming appointment I made for my child, the 1st staff member coded it wrong. This 2nd receptionist said she will record the upcoming appt as only well-visit so we shouldn't get charged. (we don't have any acute conditions). So it is possible just to get charged "nothing" for the child's well visit. But it had to coded a certain way for the upcoming appt. I see in the online records the "new patient appt" is removed and now it states "health maintenance exam".
2. But, for adults they have a different policy. So you can't be seen for your "well visit" without being seen for a new patient appt. So in this case for adults only, with a high deductible plan, you will get charged for 2 appointments with one you have to pay out of pocket.

Confusing isn't it? This is for a major health care system in California.
runner3081
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Re: Doctors visit/ included physicals

Post by runner3081 »

loveeatingpizza wrote: Mon Aug 02, 2021 10:12 am 2. But, for adults they have a different policy. So you can't be seen for your "well visit" without being seen for a new patient appt. So in this case for adults only, with a high deductible plan, you will get charged for 2 appointments with one you have to pay out of pocket.
I ran into this when trying to find a PCP at both small and systems.

To your earlier question, I declined to be seen by these facilities with the double visit. However, working in healthcare and having a HDHP, I knew how exactly the billing would have played out!
jeam3131
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Joined: Sun Aug 26, 2018 2:48 pm

Re: Doctors visit/ included physicals

Post by jeam3131 »

runner3081 wrote: Sun Aug 01, 2021 10:01 pm
loveeatingpizza wrote: Sun Aug 01, 2021 8:09 pm We are going to a new pediatrician's office in California for my healthy child (other pediatrician is no longer practicing).

They have to schedule a "new patient visit". I've asked their staff if that is the same as the once-a-year free annual well kid visit, which is what I want. We have a high deductible plan which allows for 1 free physical. Unfortunately, I asked the medical staff and they tell me to ask the billing dept, which I did, and vice versa but both could not give me an answer. I don't plan on bringing up any medical issues as my child is quite healthy.

So I am not sure if I am going to be charged for a "new patient visit" along with the "well child visit". Should I just cancel the appt and find a new pediatrician? Not sure what the standard is to charge for both a "new patient visit" and the "well child visit".
I work in healthcare and this is a new, (in my opinion) ridiculous money grab that I ran into when looking for a primary care doctor. They essentially schedule two visits, the new patient visit, which is more social, and then the annual exam. This way, the annual exam is, in theory, free, unless they find an issue, but that bill for that new patient visit and in my case, with HDHP, had to pay out of pocket for it.
Not a money grab. Not even close. If its only a preventative visit, then it should be billed as such. If you bring a whole list of other complaints outside of routine preventative care, you should be billed as such. Insurance will still "cover" the non-preventative part of the visit, but if you have a HDHP, then you are responsible for that portion of the bill. If thats the health insurance plan you have, then you have to understand your out of pocket costs for visits and procedures can be higher but with lower monthly premiums.

The pediatricians time is worth money. They went through years of training and should be compensated as such. Bringing a basket list of questions and expecting this only to be billed as preventative is not reasonable.
Broken Man 1999
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Re: Doctors visit/ included physicals

Post by Broken Man 1999 »

There seems to be a recurring theme here in Boglehead-land where someone has a HDHP, and find themselves having to pay a high deductible, thus paying a lot OOP initially.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
runner3081
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Joined: Mon Aug 22, 2016 3:22 pm

Re: Doctors visit/ included physicals

Post by runner3081 »

jeam3131 wrote: Tue Aug 03, 2021 10:46 am
runner3081 wrote: Sun Aug 01, 2021 10:01 pm
loveeatingpizza wrote: Sun Aug 01, 2021 8:09 pm We are going to a new pediatrician's office in California for my healthy child (other pediatrician is no longer practicing).

They have to schedule a "new patient visit". I've asked their staff if that is the same as the once-a-year free annual well kid visit, which is what I want. We have a high deductible plan which allows for 1 free physical. Unfortunately, I asked the medical staff and they tell me to ask the billing dept, which I did, and vice versa but both could not give me an answer. I don't plan on bringing up any medical issues as my child is quite healthy.

So I am not sure if I am going to be charged for a "new patient visit" along with the "well child visit". Should I just cancel the appt and find a new pediatrician? Not sure what the standard is to charge for both a "new patient visit" and the "well child visit".
I work in healthcare and this is a new, (in my opinion) ridiculous money grab that I ran into when looking for a primary care doctor. They essentially schedule two visits, the new patient visit, which is more social, and then the annual exam. This way, the annual exam is, in theory, free, unless they find an issue, but that bill for that new patient visit and in my case, with HDHP, had to pay out of pocket for it.
Not a money grab. Not even close. If its only a preventative visit, then it should be billed as such. If you bring a whole list of other complaints outside of routine preventative care, you should be billed as such. Insurance will still "cover" the non-preventative part of the visit, but if you have a HDHP, then you are responsible for that portion of the bill. If thats the health insurance plan you have, then you have to understand your out of pocket costs for visits and procedures can be higher but with lower monthly premiums.

The pediatricians time is worth money. They went through years of training and should be compensated as such. Bringing a basket list of questions and expecting this only to be billed as preventative is not reasonable.
We are talking about completely different things. Agree, if on annual visit, problems are brought up, they should be billed. However, some PCPs are now requiring TWO visits for a new patient (what this post was about). Thus, allowing them to receive payment for both annual and new patient visit as you can't do two per year.
FireAway
Posts: 247
Joined: Mon Jan 29, 2018 2:56 pm

Re: Doctors visit/ included physicals

Post by FireAway »

This is one of the scams being pulled by doctors/insurance companies so that they can bill you for something which the ACA requires to be provided for free. I'm a healthy person (no pre-existing conditions, no meds, nothing) but because of my age I like to get a wellness check once per year. Virtually no doctor I call will see me for my "covered" yearly wellness check without first charging me for an 'intake' visit. Of course, the intake visit does not benefit me at all - no services are rendered - so it's just a billing opportunity.

The other scam bites you if you dare to ask any questions during your wellness visit. My adult daughter (also healthy) went for her wellness visit, and asked one or two questions about minor issues that she thought might be a health concern (they were not). Just like that, her free visit now costs us $400 out of pocket, because the doctor spent 2-3 minutes "consulting" on additional topics. No lab work, specialists, or medications were prescribed, and the doctor spent less than 10 minutes with her for the entire visit.

I would love to see congress act to fix this exploitation of the intent of the law. Yearly wellness checks should be free, and they should include at least "x" minutes of time with the doctor for which s/he cannot charge extra.
jeam3131
Posts: 268
Joined: Sun Aug 26, 2018 2:48 pm

Re: Doctors visit/ included physicals

Post by jeam3131 »

runner3081 wrote: Tue Aug 03, 2021 1:21 pm
jeam3131 wrote: Tue Aug 03, 2021 10:46 am
runner3081 wrote: Sun Aug 01, 2021 10:01 pm
loveeatingpizza wrote: Sun Aug 01, 2021 8:09 pm We are going to a new pediatrician's office in California for my healthy child (other pediatrician is no longer practicing).

They have to schedule a "new patient visit". I've asked their staff if that is the same as the once-a-year free annual well kid visit, which is what I want. We have a high deductible plan which allows for 1 free physical. Unfortunately, I asked the medical staff and they tell me to ask the billing dept, which I did, and vice versa but both could not give me an answer. I don't plan on bringing up any medical issues as my child is quite healthy.

So I am not sure if I am going to be charged for a "new patient visit" along with the "well child visit". Should I just cancel the appt and find a new pediatrician? Not sure what the standard is to charge for both a "new patient visit" and the "well child visit".
I work in healthcare and this is a new, (in my opinion) ridiculous money grab that I ran into when looking for a primary care doctor. They essentially schedule two visits, the new patient visit, which is more social, and then the annual exam. This way, the annual exam is, in theory, free, unless they find an issue, but that bill for that new patient visit and in my case, with HDHP, had to pay out of pocket for it.
Not a money grab. Not even close. If its only a preventative visit, then it should be billed as such. If you bring a whole list of other complaints outside of routine preventative care, you should be billed as such. Insurance will still "cover" the non-preventative part of the visit, but if you have a HDHP, then you are responsible for that portion of the bill. If thats the health insurance plan you have, then you have to understand your out of pocket costs for visits and procedures can be higher but with lower monthly premiums.

The pediatricians time is worth money. They went through years of training and should be compensated as such. Bringing a basket list of questions and expecting this only to be billed as preventative is not reasonable.
We are talking about completely different things. Agree, if on annual visit, problems are brought up, they should be billed. However, some PCPs are now requiring TWO visits for a new patient (what this post was about). Thus, allowing them to receive payment for both annual and new patient visit as you can't do two per year.
The dual visit is a bit odd. Maybe someone here that does primary care would be able to chime in. From my understanding, it should not be that way. I'm not sure what diagnosis code they would bill the new patient visit under.

I also promise you primary care doctors are not "raking it in". Really don't need the public [offensive language removed by moderator oldcomputerguy] on them any more or else it won't be long until we don't have any more primary care doctors.
jeam3131
Posts: 268
Joined: Sun Aug 26, 2018 2:48 pm

Re: Doctors visit/ included physicals

Post by jeam3131 »

FireAway wrote: Tue Aug 03, 2021 2:10 pm This is one of the scams being pulled by doctors/insurance companies so that they can bill you for something which the ACA requires to be provided for free. I'm a healthy person (no pre-existing conditions, no meds, nothing) but because of my age I like to get a wellness check once per year. Virtually no doctor I call will see me for my "covered" yearly wellness check without first charging me for an 'intake' visit. Of course, the intake visit does not benefit me at all - no services are rendered - so it's just a billing opportunity.

The other scam bites you if you dare to ask any questions during your wellness visit. My adult daughter (also healthy) went for her wellness visit, and asked one or two questions about minor issues that she thought might be a health concern (they were not). Just like that, her free visit now costs us $400 out of pocket, because the doctor spent 2-3 minutes "consulting" on additional topics. No lab work, specialists, or medications were prescribed, and the doctor spent less than 10 minutes with her for the entire visit.

I would love to see congress act to fix this exploitation of the intent of the law. Yearly wellness checks should be free, and they should include at least "x" minutes of time with the doctor for which s/he cannot charge extra.
I don't know of a single insurance company where the approved amount for an office visit is $400. That does not make any sense
runner3081
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Re: Doctors visit/ included physicals

Post by runner3081 »

jeam3131 wrote: Tue Aug 03, 2021 2:28 pm
runner3081 wrote: Tue Aug 03, 2021 1:21 pm
jeam3131 wrote: Tue Aug 03, 2021 10:46 am
runner3081 wrote: Sun Aug 01, 2021 10:01 pm
loveeatingpizza wrote: Sun Aug 01, 2021 8:09 pm We are going to a new pediatrician's office in California for my healthy child (other pediatrician is no longer practicing).

They have to schedule a "new patient visit". I've asked their staff if that is the same as the once-a-year free annual well kid visit, which is what I want. We have a high deductible plan which allows for 1 free physical. Unfortunately, I asked the medical staff and they tell me to ask the billing dept, which I did, and vice versa but both could not give me an answer. I don't plan on bringing up any medical issues as my child is quite healthy.

So I am not sure if I am going to be charged for a "new patient visit" along with the "well child visit". Should I just cancel the appt and find a new pediatrician? Not sure what the standard is to charge for both a "new patient visit" and the "well child visit".
I work in healthcare and this is a new, (in my opinion) ridiculous money grab that I ran into when looking for a primary care doctor. They essentially schedule two visits, the new patient visit, which is more social, and then the annual exam. This way, the annual exam is, in theory, free, unless they find an issue, but that bill for that new patient visit and in my case, with HDHP, had to pay out of pocket for it.
Not a money grab. Not even close. If its only a preventative visit, then it should be billed as such. If you bring a whole list of other complaints outside of routine preventative care, you should be billed as such. Insurance will still "cover" the non-preventative part of the visit, but if you have a HDHP, then you are responsible for that portion of the bill. If thats the health insurance plan you have, then you have to understand your out of pocket costs for visits and procedures can be higher but with lower monthly premiums.

The pediatricians time is worth money. They went through years of training and should be compensated as such. Bringing a basket list of questions and expecting this only to be billed as preventative is not reasonable.
We are talking about completely different things. Agree, if on annual visit, problems are brought up, they should be billed. However, some PCPs are now requiring TWO visits for a new patient (what this post was about). Thus, allowing them to receive payment for both annual and new patient visit as you can't do two per year.
The dual visit is a bit odd. Maybe someone here that does primary care would be able to chime in. From my understanding, it should not be that way. I'm not sure what diagnosis code they would bill the new patient visit under.

I also promise you primary care doctors are not "raking it in". Really don't need the public [offensive language removed by moderator oldcomputerguy] on them any more or else it won't be long until we don't have any more primary care doctors.
I work in healthcare, I know exactly what they (and all other specialists) make :) I do agree, they are not raking it in. However, my bigger issue is with larger companies who maximize billing using tactics like this.
Broken Man 1999
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Re: Doctors visit/ included physicals

Post by Broken Man 1999 »

runner3081 wrote: Tue Aug 03, 2021 1:21 pm
jeam3131 wrote: Tue Aug 03, 2021 10:46 am
runner3081 wrote: Sun Aug 01, 2021 10:01 pm
loveeatingpizza wrote: Sun Aug 01, 2021 8:09 pm We are going to a new pediatrician's office in California for my healthy child (other pediatrician is no longer practicing).

They have to schedule a "new patient visit". I've asked their staff if that is the same as the once-a-year free annual well kid visit, which is what I want. We have a high deductible plan which allows for 1 free physical. Unfortunately, I asked the medical staff and they tell me to ask the billing dept, which I did, and vice versa but both could not give me an answer. I don't plan on bringing up any medical issues as my child is quite healthy.

So I am not sure if I am going to be charged for a "new patient visit" along with the "well child visit". Should I just cancel the appt and find a new pediatrician? Not sure what the standard is to charge for both a "new patient visit" and the "well child visit".
I work in healthcare and this is a new, (in my opinion) ridiculous money grab that I ran into when looking for a primary care doctor. They essentially schedule two visits, the new patient visit, which is more social, and then the annual exam. This way, the annual exam is, in theory, free, unless they find an issue, but that bill for that new patient visit and in my case, with HDHP, had to pay out of pocket for it.
Not a money grab. Not even close. If its only a preventative visit, then it should be billed as such. If you bring a whole list of other complaints outside of routine preventative care, you should be billed as such. Insurance will still "cover" the non-preventative part of the visit, but if you have a HDHP, then you are responsible for that portion of the bill. If thats the health insurance plan you have, then you have to understand your out of pocket costs for visits and procedures can be higher but with lower monthly premiums.

The pediatricians time is worth money. They went through years of training and should be compensated as such. Bringing a basket list of questions and expecting this only to be billed as preventative is not reasonable.
We are talking about completely different things. Agree, if on annual visit, problems are brought up, they should be billed. However, some PCPs are now requiring TWO visits for a new patient (what this post was about). Thus, allowing them to receive payment for both annual and new patient visit as you can't do two per year.
Do you go to a different doctor each year? If so you will probably continue get two bills every year. Maybe if you aren't a "new" patient, that is, you already have a history with the doctor you won't have to pay for two different activities.

I had to change my PCP of 22 years because he had covid, and cannot work full time at the moment. He was in my new PCP's office last week, and they were calling his former patients to introduce the new PCP. I don't know if I will be a "new patient" or not, my co-pay is $5, so it doesn't matter. Hopefully he will be able to come back to practice when he is in better health. At any rate, my "new" PCP was recommended by my "old" PCP, so I should be fine. Same last name, even.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
JPM
Posts: 586
Joined: Sun Aug 19, 2018 2:29 pm

Re: Doctors visit/ included physicals

Post by JPM »

I do not know what may be standard practice for an annual preventive visit in pediatrics.

In Medicare, the annual preventive visit consists of a set of examinations done at Medicare's specific request including screening exams for hearing, vision, and mental status as well as a review of and perhaps administration of appropriate vaccines and review of what screening exams have been done or need to be done (mammograms, colon cancer screening, prostate cancer screening, etc) and scheduling those if appropriate. It does not include a physical exam, blood tests, or a review of ongoing medical problems or the introduction of new problems. This annual service is free to the Medicare beneficiary.

In commercially insured patients, different doctors include and exclude different things. Generally it includes a review and updating of general medical history, surgical history, family history, immunization history, and social history. Each of these facets of health background has a section in the electronic health record. It may include a series of questions organized by organ system, asking about general condition, exercise and diet habits, adequacy of vision and hearing, presence or absence of chest pain, shortness of breath, unusual fatigue or fatiguability, abnormal bleeding from any orifice; symptoms involving stomach and bowel, kidney bladder and reproductive organs;,problems related to muscles bones, spine, back joints, or nervous system. These facets have another section in the electronic medical record. The screening exams for vision and hearing may be included. It may or may not include a review of recent tests and scheduling future tests. May or may not include a physical exam. It may or may not include an updating of ongoing problems under treatment. YMMV.
DukeofDebt
Posts: 34
Joined: Tue Aug 03, 2021 9:22 pm

Re: Doctors visit/ included physicals

Post by DukeofDebt »

I’ve always had to have a new patient consultation prior to wellness check.
toofache32
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Re: Doctors visit/ included physicals

Post by toofache32 »

Every day....
"I just want what's free."
"OK then we just check the weight and blood pressure and developmental milestones. If problems are found, that's a separate billing encounter."
"But his ear hurts."
"That's a separate encounter as I said."
"But I'm here for my free visit which should cover everything I can blurt out in 10 minutes."
User avatar
Cubicle
Posts: 1027
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Re: Doctors visit/ included physicals

Post by Cubicle »

FireAway wrote: Tue Aug 03, 2021 2:10 pmI would love to see congress act to fix this exploitation of the intent of the law. Yearly wellness checks should be free, and they should include at least "x" minutes of time with the doctor for which s/he cannot charge extra.
Sure. Let's just raise insurance premiums to cover those x extra minutes with the doctor. I'm sure the insurance companies will do everything at cost without greasing their own pockets on this line item.

Nothing is free. Even if you feel entitled to it.
$1 saved = >$1 earned. ✓
User avatar
Cubicle
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Re: Doctors visit/ included physicals

Post by Cubicle »

Edit.
$1 saved = >$1 earned. ✓
knibloe
Posts: 61
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Re: Doctors visit/ included physicals

Post by knibloe »

jeam3131 wrote: Tue Aug 03, 2021 2:40 pm
FireAway wrote: Tue Aug 03, 2021 2:10 pm This is one of the scams being pulled by doctors/insurance companies so that they can bill you for something which the ACA requires to be provided for free. I'm a healthy person (no pre-existing conditions, no meds, nothing) but because of my age I like to get a wellness check once per year. Virtually no doctor I call will see me for my "covered" yearly wellness check without first charging me for an 'intake' visit. Of course, the intake visit does not benefit me at all - no services are rendered - so it's just a billing opportunity.

The other scam bites you if you dare to ask any questions during your wellness visit. My adult daughter (also healthy) went for her wellness visit, and asked one or two questions about minor issues that she thought might be a health concern (they were not). Just like that, her free visit now costs us $400 out of pocket, because the doctor spent 2-3 minutes "consulting" on additional topics. No lab work, specialists, or medications were prescribed, and the doctor spent less than 10 minutes with her for the entire visit.

I would love to see congress act to fix this exploitation of the intent of the law. Yearly wellness checks should be free, and they should include at least "x" minutes of time with the doctor for which s/he cannot charge extra.
I don't know of a single insurance company where the approved amount for an office visit is $400. That does not make any sense
I got charged $300 last year and it was approved by the insurance company and I had to pay.
knibloe
Posts: 61
Joined: Fri Mar 27, 2020 10:29 pm

Re: Doctors visit/ included physicals

Post by knibloe »

Cubicle wrote: Tue Aug 03, 2021 10:57 pm
FireAway wrote: Tue Aug 03, 2021 2:10 pmI would love to see congress act to fix this exploitation of the intent of the law. Yearly wellness checks should be free, and they should include at least "x" minutes of time with the doctor for which s/he cannot charge extra.
Sure. Let's just raise insurance premiums to cover those x extra minutes with the doctor. I'm sure the insurance companies will do everything at cost without greasing their own pockets on this line item.

Nothing is free. Even if you feel entitled to it.
I wouldn't mind being charged for the few extra minutes and a reasonable bill for that time would lower premiums. However, what they end up charging for is a complete physical and another complete visit because you asked a couple questions. This practice drives up insurance premiums.
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Cubicle
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Re: Doctors visit/ included physicals

Post by Cubicle »

knibloe wrote: Tue Aug 03, 2021 11:13 pm
Cubicle wrote: Tue Aug 03, 2021 10:57 pm
FireAway wrote: Tue Aug 03, 2021 2:10 pmI would love to see congress act to fix this exploitation of the intent of the law. Yearly wellness checks should be free, and they should include at least "x" minutes of time with the doctor for which s/he cannot charge extra.
Sure. Let's just raise insurance premiums to cover those x extra minutes with the doctor. I'm sure the insurance companies will do everything at cost without greasing their own pockets on this line item.

Nothing is free. Even if you feel entitled to it.
I wouldn't mind being charged for the few extra minutes and a reasonable bill for that time would lower premiums. However, what they end up charging for is a complete physical and another complete visit because you asked a couple questions. This practice drives up insurance premiums.
A complete physical isn't necessary to bill for an office visit. Advice (or questions & answers) is all it takes. Even looking at something & doing nothing can be a billable event. I won't speak to the rates because that's a "negotiation" between a provider & insurance (more often the insurance just says take it or leave it).

Most professionals charge for everything they can. My lawn guy does. My mechanic does. Taco Bell charges me extra for jalapenos. My lawyer charges hundreds for a single letter. The city inspector charges full & separate for a CO recertification even though nothing changed since 120 days ago. The x-ray lab charges for repeat images.
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jeam3131
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Re: Doctors visit/ included physicals

Post by jeam3131 »

knibloe wrote: Tue Aug 03, 2021 11:08 pm
jeam3131 wrote: Tue Aug 03, 2021 2:40 pm
FireAway wrote: Tue Aug 03, 2021 2:10 pm This is one of the scams being pulled by doctors/insurance companies so that they can bill you for something which the ACA requires to be provided for free. I'm a healthy person (no pre-existing conditions, no meds, nothing) but because of my age I like to get a wellness check once per year. Virtually no doctor I call will see me for my "covered" yearly wellness check without first charging me for an 'intake' visit. Of course, the intake visit does not benefit me at all - no services are rendered - so it's just a billing opportunity.

The other scam bites you if you dare to ask any questions during your wellness visit. My adult daughter (also healthy) went for her wellness visit, and asked one or two questions about minor issues that she thought might be a health concern (they were not). Just like that, her free visit now costs us $400 out of pocket, because the doctor spent 2-3 minutes "consulting" on additional topics. No lab work, specialists, or medications were prescribed, and the doctor spent less than 10 minutes with her for the entire visit.

I would love to see congress act to fix this exploitation of the intent of the law. Yearly wellness checks should be free, and they should include at least "x" minutes of time with the doctor for which s/he cannot charge extra.
I don't know of a single insurance company where the approved amount for an office visit is $400. That does not make any sense
I got charged $300 last year and it was approved by the insurance company and I had to pay.
There may be more components to the bill than just the office visit. Insurance adjusted rates for a return office visit is usually on the range of $60-150. More for a new patient visit. I imagine there is variation depending on where you are located, but the deviations usually 2-3x different.
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Re: Doctors visit/ included physicals

Post by MishkaWorries »

DukeofDebt wrote: Tue Aug 03, 2021 9:34 pm I’ve always had to have a new patient consultation prior to wellness check.
Even lawyers give a free initial consultation.
We plan. G-d laughs.
jeam3131
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Re: Doctors visit/ included physicals

Post by jeam3131 »

This thread needs to be closed like the last one. Its a pointless discussion. Your insurance companies sets the rules for what it will and won't pay for and the guidelines for how to bill are set my the center for medicare and medicaid services. Your doctors office can't change these things.

Preventative health visits have clear parameters. Its not a "one free visit" per year coupon. If you want to know exactly what your preventative visit covers, call you insurance company and ask them. If you think the preventative visit should cover more, tell them. If you aren't happy with how much you have to pay out of pocket, chose a different health insurance plan that suits your needs. Don't expect a professional office to bill anything less than its entitled to based on rules set not by them, but by the government.
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Re: Doctors visit/ included physicals

Post by LittleMaggieMae »

I'm hearing about the "two visit" thing more and more. One example: A friend needed to have a tooth extracted - her dentist didn't do (it's complicated) it so she was referred to someone who did. She set up an appointment - thinking the tooth would be extracted at that appt. but it was an appt so she could fill out the "paperwork" - sit in a room - and meet the dentist who would extract her tooth. She was charged for the "Hi! I'm the dentist who will extract your tooth! Any questions?" meeting. She had to schedule the extraction for a later date. She had other "meet and greet" appoints that she was charged for as well for other tests/exams and such. (FWIW: the tooth extraction took 30 minutes from the time she walked in the door to the time she was ready to be picked up to leave... I drove her to the appointment. We had 2 trips to the dentist for this. She spent about 30 minutes for the meet and greet appoint too - waiting, filling out a form, being ushered to a room, waiting to say "Hi!" to the surgeon and then leaving. The extraction place got 2 payments - and we spent alot of wasted time (the say Hi! appt took just as much of our time as the extraction appt.)

Her learned lesson was - there is a way for the office to code the "meet and greet" appointment so insurance will cover it. You have to be persistent and may have to talk to multiple people involved to get the right coding. You can also ASK if you are making a "meet and greet" appoint or an appointment for actual service. If it's a "meet and greet" you can ask if you can fill out the paper work BEFORE hand and skip the meet and greet appointment. You can find out all that info on the phone before you go for the first appt.

I've heard about the "Meet and Greet" thing from many people - some thought it was nice and friendly and others were angry that they wasted 3 or 4 hours of their time (to schedule, to go to, sit and wait, spend 10 minutes filling out forms, sit and wait, spend 5 minutes saying "Hello!" and then leaving to go home.) And then to have to schedule the actual appointment which might also take up 3 or 4 hours of their time - for the 15 minutes they needed to see the doctor.
jeam3131
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Re: Doctors visit/ included physicals

Post by jeam3131 »

LittleMaggieMae wrote: Wed Aug 04, 2021 10:08 am I'm hearing about the "two visit" thing more and more. One example: A friend needed to have a tooth extracted - her dentist didn't do (it's complicated) it so she was referred to someone who did. She set up an appointment - thinking the tooth would be extracted at that appt. but it was an appt so she could fill out the "paperwork" - sit in a room - and meet the dentist who would extract her tooth. She was charged for the "Hi! I'm the dentist who will extract your tooth! Any questions?" meeting. She had to schedule the extraction for a later date. She had other "meet and greet" appoints that she was charged for as well for other tests/exams and such. (FWIW: the tooth extraction took 30 minutes from the time she walked in the door to the time she was ready to be picked up to leave... I drove her to the appointment. We had 2 trips to the dentist for this. She spent about 30 minutes for the meet and greet appoint too - waiting, filling out a form, being ushered to a room, waiting to say "Hi!" to the surgeon and then leaving. The extraction place got 2 payments - and we spent alot of wasted time (the say Hi! appt took just as much of our time as the extraction appt.)

Her learned lesson was - there is a way for the office to code the "meet and greet" appointment so insurance will cover it. You have to be persistent and may have to talk to multiple people involved to get the right coding. You can also ASK if you are making a "meet and greet" appoint or an appointment for actual service. If it's a "meet and greet" you can ask if you can fill out the paper work BEFORE hand and skip the meet and greet appointment. You can find out all that info on the phone before you go for the first appt.

I've heard about the "Meet and Greet" thing from many people - some thought it was nice and friendly and others were angry that they wasted 3 or 4 hours of their time (to schedule, to go to, sit and wait, spend 10 minutes filling out forms, sit and wait, spend 5 minutes saying "Hello!" and then leaving to go home.) And then to have to schedule the actual appointment which might also take up 3 or 4 hours of their time - for the 15 minutes they needed to see the doctor.
While what you are saying seems logical, most medical professionals will want to see the patient first before scheduling them for a procedure. Scheduling a patient for a procedure requires taking a larger time slot out of their day. Many times, patients are referred for a particular procedure, but when the medical professional performing the procedure evaluates the case, plans can change. While your friend may have a seemingly straightforward case, its not always that simple or many times people come in with completely incorrect diagnoses often which require nothing. Medical professionals would be burning time slots left and right if they promised lengthy procedures same day and patient wait times to get in would be even longer.
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Re: Doctors visit/ included physicals

Post by Cobra Commander »

I have fed BCBS and I have two toddlers so I have done a lot of wellness visits over the past two years. There is no rhyme or reason whatsoever as to whether we get charged a co-pay (i.e. more than a wellness visit). Sometimes we ask questions and get charged a co-pay, sometimes not. Sometimes we don't ask any questions at all and get charged a co-pay, sometimes no co-pay. We have two doctors that we see at the practice and it seems to vary even with the individual doctor as to whether the visit falls within the confines of a wellness visit or not.

At the end of the day I'm lucky that the randomness of billing only costs me $30 but the complete lack of transparency is somewhat annoying. I don't think the doctors are trying to scam me or anything and maybe there's some billing clerk in the back that is responsible for the randomness I experience.
Young Boglehead
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Re: Doctors visit/ included physicals

Post by Young Boglehead »

I’d imagine the no rhyme or reading feeling is coming from incompetence in business; you probably should be paying the highest bill/copay every time but the staff forgets or coded it wrong. Happens all the time.
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Re: Doctors visit/ included physicals

Post by Broken Man 1999 »

DukeofDebt wrote: Tue Aug 03, 2021 9:34 pm I’ve always had to have a new patient consultation prior to wellness check.
Are you going to a new doctor every year?

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
jeam3131
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Re: Doctors visit/ included physicals

Post by jeam3131 »

Cobra Commander wrote: Wed Aug 04, 2021 11:52 am I have fed BCBS and I have two toddlers so I have done a lot of wellness visits over the past two years. There is no rhyme or reason whatsoever as to whether we get charged a co-pay (i.e. more than a wellness visit). Sometimes we ask questions and get charged a co-pay, sometimes not. Sometimes we don't ask any questions at all and get charged a co-pay, sometimes no co-pay. We have two doctors that we see at the practice and it seems to vary even with the individual doctor as to whether the visit falls within the confines of a wellness visit or not.

At the end of the day I'm lucky that the randomness of billing only costs me $30 but the complete lack of transparency is somewhat annoying. I don't think the doctors are trying to scam me or anything and maybe there's some billing clerk in the back that is responsible for the randomness I experience.
By the time you reach the front desk, the only coding thats entered into the computer was autogenerated from the EMR. It often gets manually fixed at the end of the day when the doctor has more time to complete their charting, which could change whether you owe a copay or not. If you were charged and then it turns out it wasn't needed, you should get a credit or a refund.
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Cobra Commander
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Re: Doctors visit/ included physicals

Post by Cobra Commander »

jeam3131 wrote: Wed Aug 04, 2021 1:00 pm
Cobra Commander wrote: Wed Aug 04, 2021 11:52 am I have fed BCBS and I have two toddlers so I have done a lot of wellness visits over the past two years. There is no rhyme or reason whatsoever as to whether we get charged a co-pay (i.e. more than a wellness visit). Sometimes we ask questions and get charged a co-pay, sometimes not. Sometimes we don't ask any questions at all and get charged a co-pay, sometimes no co-pay. We have two doctors that we see at the practice and it seems to vary even with the individual doctor as to whether the visit falls within the confines of a wellness visit or not.

At the end of the day I'm lucky that the randomness of billing only costs me $30 but the complete lack of transparency is somewhat annoying. I don't think the doctors are trying to scam me or anything and maybe there's some billing clerk in the back that is responsible for the randomness I experience.
By the time you reach the front desk, the only coding thats entered into the computer was autogenerated from the EMR. It often gets manually fixed at the end of the day when the doctor has more time to complete their charting, which could change whether you owe a copay or not. If you were charged and then it turns out it wasn't needed, you should get a credit or a refund.
I don't find out about the co-pay until I get the EOB from the insurance company which I guess means the doctor's office doesn't know whether the procedures they performed or are billing for exceed the scope of what my insurance covers for wellness visits and that's fine. I just think it's odd that visits that appear to be identical and cover basic stuff vary in whether they exceed the scope of a wellness visit which suggests that there's some subjectivity in how things are coded by either the doctor or the billing people.
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Re: Doctors visit/ included physicals

Post by jeam3131 »

Cobra Commander wrote: Wed Aug 04, 2021 1:08 pm
jeam3131 wrote: Wed Aug 04, 2021 1:00 pm
Cobra Commander wrote: Wed Aug 04, 2021 11:52 am I have fed BCBS and I have two toddlers so I have done a lot of wellness visits over the past two years. There is no rhyme or reason whatsoever as to whether we get charged a co-pay (i.e. more than a wellness visit). Sometimes we ask questions and get charged a co-pay, sometimes not. Sometimes we don't ask any questions at all and get charged a co-pay, sometimes no co-pay. We have two doctors that we see at the practice and it seems to vary even with the individual doctor as to whether the visit falls within the confines of a wellness visit or not.

At the end of the day I'm lucky that the randomness of billing only costs me $30 but the complete lack of transparency is somewhat annoying. I don't think the doctors are trying to scam me or anything and maybe there's some billing clerk in the back that is responsible for the randomness I experience.
By the time you reach the front desk, the only coding thats entered into the computer was autogenerated from the EMR. It often gets manually fixed at the end of the day when the doctor has more time to complete their charting, which could change whether you owe a copay or not. If you were charged and then it turns out it wasn't needed, you should get a credit or a refund.
I don't find out about the co-pay until I get the EOB from the insurance company which I guess means the doctor's office doesn't know whether the procedures they performed or are billing for exceed the scope of what my insurance covers for wellness visits and that's fine. I just think it's odd that visits that appear to be identical and cover basic stuff vary in whether they exceed the scope of a wellness visit which suggests that there's some subjectivity in how things are coded by either the doctor or the billing people.
Agree. Preventative health/well checkup shouldn't have copays. Im guessing its being billed incorrectly. Not everyone knows how to bill correctly.
FireAway
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Re: Doctors visit/ included physicals

Post by FireAway »

I understand that if I go in for a wellness check, and report some symptom that requires significant extra time/materials/tests etc, then a doctor will probably need to bill extra.

But what I'm seeing is more along the lines of saying, "Doc, I wake up Saturday mornings with a headache a lot. Should I be worried?"
Doc: "what do you do Friday nights?"
Patient: "Go out drinking with my buddies"
Doc: "Well, probably just a hangover. Drink more water and take a couple ibuprofen before you go to bed. COme back and talk to me if it starts happening more frequently, when you haven't been drinking".

Boom! Patient gets billed an extra $100 for "migraine consultation" or whatever the code is. If a patient is there for a yearly wellness visit, and asks this type of question, I don't think the doc should get to add $100 to what should have been a free visit, for 30 seconds of work. In fact, the patient probably wouldn't haven't even bothered to consult a doctor, except that he happened to be sitting in the doctor's office for a yearly visit that he and his insurance company have already paid for. This is just padding the bill.
Random Poster
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Re: Doctors visit/ included physicals

Post by Random Poster »

Cubicle wrote: Tue Aug 03, 2021 11:26 pm My lawyer charges hundreds for a single letter.
Do you get a discount if you ask for the whole alphabet?

More on point, it seems pretty clear to me which respondents are in the medical field and which ones aren’t, as there is a lot of bias showing and there seems to a lot of finger pointing going on. But when calling the doctor’s office to get pricing details beforehand is a near impossibility, one wonders if such a practice benefits more than just the insurance companies.

Regardless, I tend to think that there is a solution to all of these medical billing problems, but it unfortunately cannot be stated here.
jeam3131
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Re: Doctors visit/ included physicals

Post by jeam3131 »

Random Poster wrote: Wed Aug 04, 2021 4:00 pm
Cubicle wrote: Tue Aug 03, 2021 11:26 pm My lawyer charges hundreds for a single letter.
Do you get a discount if you ask for the whole alphabet?

More on point, it seems pretty clear to me which respondents are in the medical field and which ones aren’t, as there is a lot of bias showing and there seems to a lot of finger pointing going on. But when calling the doctor’s office to get pricing details beforehand is a near impossibility, one wonders if such a practice benefits more than just the insurance companies.

Regardless, I tend to think that there is a solution to all of these medical billing problems, but it unfortunately cannot be stated here.
Most people outside of the medical field don't understand the reality of medical billing, whos in charge, and who sets the rules. Its not so simple. If it was, it would have been done already.

If you want things ala carte, go the route of direct pay practices. Its out there if you want it.
getthatmarshmallow
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Re: Doctors visit/ included physicals

Post by getthatmarshmallow »

My experience with the pediatrician is that a well-child visit is covered annually, and it's not too hard to get them to bill it properly. We have a HDHP, and I've never been billed for the kids' annual exam. That covers developmental milestones, height/weight/vision, and vaccines.

This isn't to say that medical billing isn't crazy. The doctor doesn't know in advance what the code is, the billing can't tell you what it will cost unless you know the code, and you're expected to 'shop around' with no prices. But this should be easy. Just ask for a well-child visit.
DukeofDebt
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Re: Doctors visit/ included physicals

Post by DukeofDebt »

Broken Man 1999 wrote: Wed Aug 04, 2021 12:44 pm
DukeofDebt wrote: Tue Aug 03, 2021 9:34 pm I’ve always had to have a new patient consultation prior to wellness check.
Are you going to a new doctor every year?

Broken Man 1999
I stated that wrong. What I meant to say was that any time I've seen a new PCP, I've had to have a new patient consultation before any "real" appointments. That said, there was a period of time when I did have to see a new doctor every two or three years simply because our healthcare market was very dynamic and Doctors were moving around a lot. Sometimes they would "piggyback" the appointments, so that I would get the wellness check for free but pay an incremental amount for the lowest level "regular" engagement for discussion of ongoing conditions (which just about everybody has).
DukeofDebt
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Re: Doctors visit/ included physicals

Post by DukeofDebt »

MishkaWorries wrote: Wed Aug 04, 2021 9:37 am
DukeofDebt wrote: Tue Aug 03, 2021 9:34 pm I’ve always had to have a new patient consultation prior to wellness check.
Even lawyers give a free initial consultation.
LOL. Very true. Although, in some areas only the mediocre lawyers give free consultations. The good ones still charge. :happy

I'm guessing that this is mostly an issue for people on HDHPs. We've been on both, and when it's only a $30 co-pay at stake, it doesn't much matter. When HDHP turns that into a $200 office visit, it's worth poking at a bit more.
Broken Man 1999
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Re: Doctors visit/ included physicals

Post by Broken Man 1999 »

DukeofDebt wrote: Fri Aug 06, 2021 11:55 am
Broken Man 1999 wrote: Wed Aug 04, 2021 12:44 pm
DukeofDebt wrote: Tue Aug 03, 2021 9:34 pm I’ve always had to have a new patient consultation prior to wellness check.
Are you going to a new doctor every year?

Broken Man 1999
I stated that wrong. What I meant to say was that any time I've seen a new PCP, I've had to have a new patient consultation before any "real" appointments. That said, there was a period of time when I did have to see a new doctor every two or three years simply because our healthcare market was very dynamic and Doctors were moving around a lot. Sometimes they would "piggyback" the appointments, so that I would get the wellness check for free but pay an incremental amount for the lowest level "regular" engagement for discussion of ongoing conditions (which just about everybody has).
Makes sense to me. Seems necessary, though, if you are changing so often. Fortunately I had long-term history with my PCP.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven then I shall not go." - Mark Twain
UALflyer
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Re: Doctors visit/ included physicals

Post by UALflyer »

FireAway wrote: Tue Aug 03, 2021 2:10 pm This is one of the scams being pulled by doctors/insurance companies so that they can bill you for something which the ACA requires to be provided for free. I'm a healthy person (no pre-existing conditions, no meds, nothing) but because of my age I like to get a wellness check once per year. Virtually no doctor I call will see me for my "covered" yearly wellness check without first charging me for an 'intake' visit. Of course, the intake visit does not benefit me at all - no services are rendered - so it's just a billing opportunity.
I sympathize with your complaint here, but for primary care physicians, new patients tend to be very time consuming. An overwhelming majority of people actually do have health issues or at least health concerns, and it would be extraordinarily unusual to get a person with zero pre-existing conditions, zero family history of any health issues and otherwise perfect health. Hence, the reason that a number of primary care practices now require an initial intake visit before they will schedule an annual physical.

An annual physical isn't designed for, and doesn't allow enough time for, a physician to "get to know" a new patient to figure out all the various health concerns that should be monitored.

The part that I don't understand is the fact that this seems to be a significant issue for you. Do you change your primary care physicians every year? If so, why?
The other scam bites you if you dare to ask any questions during your wellness visit. My adult daughter (also healthy) went for her wellness visit, and asked one or two questions about minor issues that she thought might be a health concern (they were not). Just like that, her free visit now costs us $400 out of pocket, because the doctor spent 2-3 minutes "consulting" on additional topics. No lab work, specialists, or medications were prescribed, and the doctor spent less than 10 minutes with her for the entire visit.

I would love to see congress act to fix this exploitation of the intent of the law.
It's quite different than you think. The proliferation of the HDHP's has lots and lots of people trying to save money by reducing regular office visits and, instead, trying to use an annual physical as an opportunity to bring up a laundry list of health issues and concerns, which significantly extends the appointment time and causes it not to be a well visit.

I've been on the other side of this as well, and am aware of the confusion and frustration that comes with innocently discussing a health concern that causes the billing department to change the coding of the visit. It's just a much more complex issue than a lot of people realize.
Yearly wellness checks should be free, and they should include at least "x" minutes of time with the doctor for which s/he cannot charge extra.
Up until just a few years ago, there was no such thing as a "free" annual physical. Then, as part of the ACA, a theory was adopted that preventive care not only results in better health outcomes but can also save money by giving the system a chance to identify and address health issues early, before they become more serious. The problem is that this theory doesn't work so well in practice, as this so-called free preventive annual physical includes only specific lab tests and screenings, which is all that's paid for. A ton of things fall outside the scope of such a preventive annual physical. Further, if people are encouraged to forego their office visits, defer care and wait until their annual physical to discuss their health concerns, which is what your suggestion would accomplish, then the system is actually encouraging them to delay care, which will do the exact opposite of what a preventive care visit is designed to accomplish.
Last edited by UALflyer on Fri Aug 06, 2021 1:42 pm, edited 1 time in total.
DukeofDebt
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Re: Doctors visit/ included physicals

Post by DukeofDebt »

Broken Man 1999 wrote: Fri Aug 06, 2021 12:17 pm
DukeofDebt wrote: Fri Aug 06, 2021 11:55 am
Broken Man 1999 wrote: Wed Aug 04, 2021 12:44 pm
DukeofDebt wrote: Tue Aug 03, 2021 9:34 pm I’ve always had to have a new patient consultation prior to wellness check.
Are you going to a new doctor every year?

Broken Man 1999
I stated that wrong. What I meant to say was that any time I've seen a new PCP, I've had to have a new patient consultation before any "real" appointments. That said, there was a period of time when I did have to see a new doctor every two or three years simply because our healthcare market was very dynamic and Doctors were moving around a lot. Sometimes they would "piggyback" the appointments, so that I would get the wellness check for free but pay an incremental amount for the lowest level "regular" engagement for discussion of ongoing conditions (which just about everybody has).
Makes sense to me. Seems necessary, though, if you are changing so often. Fortunately I had long-term history with my PCP.

Broken Man 1999
Fortunately, that was in the past. Several other members of our family had an outstanding PCP that I could never see because she had a long new patient waiting list. I got lucky when she changed partnerships and suddenly could accept new patients. That lasted about 2 days. :P I'm in a better place now. 8-)
UALflyer
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Re: Doctors visit/ included physicals

Post by UALflyer »

FireAway wrote: Wed Aug 04, 2021 2:05 pm I understand that if I go in for a wellness check, and report some symptom that requires significant extra time/materials/tests etc, then a doctor will probably need to bill extra.
You are trying to apply your own set of rules to the encounter, but the rules that govern it are different. You think of an annual physical as a "free" visit where you can discuss whatever you want, as long as this discussion does not require "significant" extra time. That's very different from the requirements set forth in both the federal law and in the insurance contracts.

To understand what's going on, at some point you may want to pull up your health plan's summary plan description and read the specific list of what is covered in your annual physical. Think of it as a specific checklist of health screenings that are performed, which includes both specific lab tests and specific health questions. For insurance purposes, anything that is outside the scope of this list isn't covered by a well visit.

Again, I get the frustration and have experienced it myself, but have also mentioned the reasons that it is set up this way. Namely, that only specific annual health screenings are deemed to improve health outcomes and arguably save the system money. If you give people an incentive to avoid discussing health concerns until their "free" annual visit, you undermine the early intervention rationale behind preventive care.
Last edited by UALflyer on Fri Aug 06, 2021 4:54 pm, edited 2 times in total.
FireAway
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Re: Doctors visit/ included physicals

Post by FireAway »

UALflyer wrote: Fri Aug 06, 2021 1:01 pm Hence, the reason that a number of primary care practices now require an initial intake visit before they will schedule an annual physical.


And yet, most "intake" visits that I am aware of consist of the patient filling out forms. There is zero value received by the patient.

UALflyer wrote: Fri Aug 06, 2021 1:01 pm An annual physical isn't designed for, and doesn't allow enough time for, a physician to "get to know" a new patient to figure out all the various health concerns that should be monitored.
So if I need that from a doctor, I should be able to request, and be charged for, that. But I don't have various health concerns that should be monitored, nor do I want to pay hundreds of dollars out of pocket to for the privilege of filling out forms. I should be given the choice.
UALflyer wrote: Fri Aug 06, 2021 1:01 pm Further, if people are encouraged to forego their office visits, defer care and wait until their annual physical to discuss their health concerns, which is what your suggestion would accomplish, then the system is actually encouraging them to delay care, which will do the exact opposite of what a preventive care visit is designed to accomplish.
I think you've got this quite backwards. I'm only suggesting that a doctor spend a reasonable (and defined) amount of time with a patient during a wellness visit. Everyone understands that if they come in with a laundry list of items, there's not going to be time to cover in a wellness check. They're not going to defer serious health concerns in the hope that maybe they can get a question answered for free.

What's happening now - in my family, and in others that I'm aware of - is that they are putting off wellness checks, or keeping their mouth shut and not bringing up any concerns at all during the visit, because they know they're likely to get a bill that runs in the hundreds of dollars, often with little or no benefit to them. This is the exact opposite of what the ACA's preventative care goals are designed to accomplish, and needs to be fixed.
UALflyer
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Re: Doctors visit/ included physicals

Post by UALflyer »

FireAway wrote: Fri Aug 06, 2021 2:23 pm And yet, most "intake" visits that I am aware of consist of the patient filling out forms. There is zero value received by the patient.
New patient workups consist of a lot more than the patient filling out forms. At least they should, as the patient should be meeting with the physician to discuss what is and isn't on the forms and, when necessary, to go over some of the answers in depth.
if I need that from a doctor, I should be able to request, and be charged for, that. But I don't have various health concerns that should be monitored, nor do I want to pay hundreds of dollars out of pocket to for the privilege of filling out forms. I should be given the choice.
Yes, if every single one of us could be relied upon to provide complete and accurate information up front, we'd all have this choice. Unfortunately, however, a huge number of people make the exact same claim, but then have a list of things to discuss.
I think you've got this quite backwards. I'm only suggesting that a doctor spend a reasonable (and defined) amount of time with a patient during a wellness visit.
I understand what you're suggesting, which isn't new. As I've explained above, there is a reason that an annual physical is set up very differently under both the ACA and under the insurance contracts, as implementing your suggestion would undermine the rationale behind requiring certain very specific preventative care labs and screenings to be provided at no additional charge, while charging for the other ones.

You disagree with the way the system is set up, which is perfectly fine, and I am sure that all of us have a giant list of things that we'd like to fix and improve. I am sure that there's a better way to address the issues that you're complaining about, but there are also reasons other than greed behind the existing setup, which you aren't really thinking about. I get the complaint, which is well known. The problem is that you are only thinking about one side -- yours. There are other sides and considerations here, which is the reason that it's more complex than you give it credit for.
FireAway
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Re: Doctors visit/ included physicals

Post by FireAway »

UALflyer wrote: Fri Aug 06, 2021 2:49 pm You disagree with the way the system is set up, which is perfectly fine, and I am sure that all of us have a giant list of things that we'd like to fix and improve. I am sure that there's a better way to address the issues that you're complaining about
OK. My solution is pretty straightforward. "Every patient gets a free wellness check every year which includes 30 minutes of time with a primary care physician".

What's the better way?
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