Medical Billing Question - Double Billed for Preventative Visit?

[shh]

I know, right? I haven't been to a primary care in ages, but at my regular eye exam, dental exam, gyn exam they always ask during the appointment if I have any questions or concerns. What can you bring up then without being out of the scope of your annual exam?

There are laws against "bait and switch" and misleading pricing - but seems none of that applies in the medical world where the patient is swimming in a pool of sharks - the sharks being physician billing practices, health insurers and US healthcare dysfunction in general.

(I'm sure doctors hate it too - they'd much rather hear patient concerns and address any issues proactively, but they're stuck in the same stupid system.)

This whole "wellness exam" concept creates hassles and surprise charges for millions of patients. It's ridiculous: every insurance company should clearly articulate EXACTLY what you can and cannot ask during a wellness exam. Or if you cannot ask ANYTHING and must refuse to answer specific questions- they should clearly specify that as well.

 

[mom2rtk]

none of that applies in the medical world where the patient is swimming in a pool of sharks - the sharks being physician billing practices, health insurers and US healthcare dysfunction in general.

You are not wrong.

 

[JulieBeeRN]

To the OP, I'm glad that they figured out your bill. The problem can be that people (not the OP) will bring up all kinds of medical concerns that cannot be addressed in the time span allotted for a physical. Not only will that throw the schedule off; but the physician would be compensated incorrectly for that time.

It sounds like this was a mistake on the insurance side; but there needs to be signage AND physicians need to inform the family/patient if they will need to bill them more or bring it up at a different appointment.

 

[tzolkin]

Genuine question, not trying to be snarky. What is within the scope of an annual physical?

I now wish I would have taken a picture because they did give a list of examples that would trigger the additional office visit bill. But, basically what's included is a physical examination, brief overview of your current meds, and certain preventative tests that are relevant for your age/sex/etc-- bloodwork to check for things like high cholesterol or diabetes, cancer screening, immunizations, etc.

Any complaints that are something that a person would typically schedule a doctor's visit for would be considered a separate visit. This includes:

• Discussion of any new health problem, illness or injury.
• Management of chronic, ongoing health problems and/or medications.

Thinking on this, how does a preventative visit work if you can't say anything that has been bothering you but hasn't been diagnosed yet?

I mean, in a quite literal sense, a preventative visit should be to prevent a small thing from getting bigger and more expensive but you can't say anything...

I know it makes logical sense and is always a good idea to prevent a small thing from getting bigger, but unfortunately, that's not what preventive care is when referring to doctors appointments. Preventive care is for when you're feeling well and not experiencing any symptoms. The goal is to keep you healthy and check for routine things that you may not otherwise notice.

If you already are experiencing a problem that hasn't been diagnosed, that would be considered diagnostic care. So for that, you would be billed for a "problem" visit not a preventive visit.

Here's a list of what the US Dept of Health considers preventive care:

• Blood pressure, diabetes, and cholesterol tests
• Many cancer screenings, including mammograms and colonoscopies
• Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use
• Regular well-baby and well-child visits
• Routine vaccinations against diseases such as measles, polio, or meningitis
• Counseling, screening, and vaccines to ensure healthy pregnancies
• Flu shots and other vaccines

 

[tony67]

I really dislike the entire medical system.

I used to write medical billing software and honestly it was all about how to not pay a claim within the rules of the insurance. Even if you delayed paying for a period of time that was a positive. Yes there is a thing called karma.

The worst thing - beyond the ever-increasing costs - is all this PCP stuff. It extremely hard to find a PCP in my area - and it depends on your health plan.

I have paid a lot for my insurance and cant really use it - and to be clear it was Blue Cross Blue shield - supposedly the gold standard. There was one PCP available within 40 miles of me - they are very old and not a good doctor at all - I blame them for the death of my father and the very close call of my brother...who is in very bad shape now - so I really did not want to use this person. To be clear my brother would most likely be dead had he taken the advice of this doctor - but instead he took himself to the emergency room where they addressed the issue and were surprised he was not dead.
He still uses them because he needs someone to sign off as PCP and its easy to get an appointment for that - and every time he sign off on something its an office visits billed to insurance.
We are 5 minutes from a very big hospital -so its not like I am out in the boonies - there are so many doctors around that hospital its mind boggling - but they are not a PCP or not taking new patients.

I was finally able to get a PCP when I changed plans - but I have to wait 6 months for an actual visit and they wont sign off on anything that was already scheduled or renew an RX without seeing us. The plans require signoff from the PCP to pay so its a catch 22. We had to go into urgent care and see someone in the same practice to get a test covered that had already been scheduled for months. Something that was already causing stress.

Then there is the answer to everything a magic pill - well that is not always the answer. One pill causes a side affect that is worse than the original issue, then you get another pill to address the side affect - rinse repeat.. over and over.

All that said - I still would not want a system like the UK Ireland or Canada - they all have their own issues as well - no idea how we fix any of these things tbh.

Last thing to take it back to the OP who has addressed their issue I think - don't worry to much about an EOB unless its says its not covered, wait for the bill from the doctor. Then be sure to compare the two and make sure everything was properly billed and credited. Mistakes happen all the time.

 

[luisov]

Wow, that's incredibly frustrating!

 

[georgina]

We are 5 minutes from a very big hospital -so its not like I am out in the boonies - there are so many doctors around that hospital its mind boggling - but they are not a PCP or not taking new patients.

There needs to be incentives for med school graduates to go into family care. Right now specialities are much more lucrative. PCP's are asked to do a lot, see too many patients a day and don't feel they have enough time to spend with them. Doctors are leaving the internal medicine/family care field because of burnout. As the population of the country ages more, there is going to be even more issues.

 

[mom2rtk]

The double billing might be because talking about anxiety and getting meds is seen as a separate visit from the wellness exam. Insurance often handles these differently. It's a pain, but it does happen.

I agree this is likely the answer. But it's ridiculous because most providers ASK in the course of a wellness visit how your mental health is since your last visit. Some have screening questionnaires they have patients fill out before the physical.

 

[disneychrista]

The double billing might be because talking about anxiety and getting meds is seen as a separate visit from the wellness exam. Insurance often handles these differently. It's a pain, but it does happen.

Isn’t this part of what a wellness exam is for? To pinpoint issues a patient is having ?

 

[focusondisney]

There was another thread on this same topic. My response there was if you can discuss new issues with the doctor all depends on the medical office policies. I accompanied my elderly parents to all medical appointments for about 10 years, including annual wellness visits. Both their primary MD & the NP were exceptionally thorough, usually spending about an hour for the annual wellness visit & the 6 month visit. The 6 month visit had a copay, the annual wellness visit never did, no matter what was discussed or if new problems were addressed. Besides my parents medical visits, my husband & I have been on Medicare for 2 years. Our primary care doctor is in a different medical group than my parent’s. Our physician & his PAs also discuss all issues at our AWV with no restrictions or additional fee.

Medicare requires certain things must be discussed but doesn’t prohibit the physician from addressing other issues without charging an additional fee. This is an office policy. The physician or whoever owns the practice has decided that they will only address the minimum requirements in the wellness visit. And that anything else must be a separate visit. Not all offices operate that way.

 

[Lehuaann]

I’ve been double billed and learned my lesson never to ask questions during preventative exams.

However, here’s a new one. Went to the same place today and I was only allowed to discuss one issue. If I wanted to address a separate ongoing issue, I had to book another visit. I booked this visit to address both. In the end, they would not call in a much needed 6 month followup ultrasound unless I booked another visit. I could not believe it.

 

[focusondisney]

I’ve been double billed and learned my lesson never to ask questions during preventative exams.

However, here’s a new one. Went to the same place today and I was only allowed to discuss one issue. If I wanted to address a separate ongoing issue, I had to book another visit. I booked this visit to address both. In the end, they would not call in a much needed 6 month followup ultrasound unless I booked another visit. I could not believe it.

Yea, and the problem gets worse while you wait for another appointment. That’s ridiculous but it’s on your physician group, not your insurance. Unfortunately, it’s not easy to change doctors, so there may not be anything you can do about it.

 

[Lehuaann]

Yea, and the problem gets worse while you wait for another appointment. That’s ridiculous but it’s on your physician group, not your insurance. Unfortunately, it’s not easy to change doctors, so there may not be anything you can do about it.

I was able to call back today and speak to the head nurse. She read the previous MD’s notes and booked the ultrasound no problem. No extra visit was ever required. The visit yesterday was with an NP. Coincidentally, the double billing also happened under a NP. I used to work for a husband/wife team of MDs, and we never operated like that.

 

[DisneyTarheel]

My PCP recently charged me $426 to take my blood pressure. $213 for systolic and $213 for diastolic. What a country we live in. (sigh)

 

[DisneyTarheel]

The double billing might be because talking about anxiety and getting meds is seen as a separate visit from the wellness exam. Insurance often handles these differently. It's a pain, but it does happen.

Could be. This was also a follow-up visit, so perhaps that had an impact, too. They are going to love me next time when I tell them not to take my BP since I take it at home.

 

[Deanna Lamz]

The double billing might be because talking about anxiety and getting meds is seen as a separate visit from the wellness exam. Insurance often handles these differently. It's a pain, but it does happen.

When you call, ask your insurance and the doctor’s office how they count these visits. In my experience, a virtual assistant in medical billing really helps with these issues. They make sure bills are right and on time, so you can worry less about surprise charges and more about your health.