I had my annual check up and according to the Law and my insurance company you are supposed to get one free check up a year off your insurance plan. So what could go wrong.
Well, the doctor’s office billed me almost the whole cost of the checkup. All the labs and testing were not paid for by the insurance company. So I called the doctor’s office and talked to them, and they said I would have to contact the insurance company. I called the insurance company and talked to a representative. I explained to him that I was supposed to get one free check up a year. He agreed, and we conferenced on the doctor’s office, and he explained to them how to code it. The woman at the Doctor’s office listened to him and submitted the claim, I assume, exactly how he told her to.
A couple of weeks later, I get another bill from the Doctor’s office for half of what the bill was. The bill isn’t enormous, and it is almost worth it to just pay it. But the insurance company is supposed to pay the bill. Now I can understand the mix-up the first time but now, after the insurance company told the billing department at the doctor’s office how to bill it, and they still rejected half? After explicitly being told this was an annual check up? This is why people are getting so mad at the insurance companies.
What did the details of your annual physical cover? Did you discuss any health issues that weren’t in the list? Did you have any blood tests that weren’t on the list? Did the bill contain a “facilities charge” that wasn’t covered by a doctor’s office checkup?
I assume that you have company-paid insurance. It’s just as important for people covered by Medicare. We get a free annual “health and wellness” checkup. But if we talk about any specific medical problem it loses the freebie and gets charged.
My first checkup on Medicare was billed to me at full boat. I did the legwork, and found Medicare has three codes: “welcome to Medicare”, “first annual checkup”. and “subsequent annual checkup”. The doc had coded for “subsequent annual checkup”, which was rejected, because there had been no billing for the “welcome” visit, or the “first annual”. So, I went back to the doc’s office and barked at them. They rebilled, under the “first annual” code, which, of course, was rejected again. I finally found a web site that spelled out when each code is to be used, so simply and clearly, that even a doctor could understand. Printed out that diagram, and gave it to the clerk at the doc’s office. She exclaimed “I never saw anything like that before” and gave it to the doc. That time, they billed correctly, and Medicare paid.
Some years later, the doc decided I was a candidate for a test, that Medicare pays 100% for. They coded it wrong, and I got a bill. I barked at them, so they resubmitted, with the right code. I got another bill. I called Medicare, asking why they didn’t pay 100%. The Medicare agent used a term along the lines of “assumed payment”, meaning they assumed the doc coded it correctly, and paid what Medicare would pay under that code, and they considered the case closed.
Wendy I had an annual check up that I get every year and that was paid previously by the insurance company every year. There was nothing that the doctor’s office did that they haven’t done for every annual. Maybe they have someone new in the Billing department but the insurance company told them how to bill it, after I contacted them.
No I pay for my own insurance but as you stated with Medicare the same thing goes with my insurance. Remember the insurance agent agreed with me that it all should be paid for. It was an annual exam.
I hate that. My previous PCP was a bit flexible about that. I’d go in for a check-up, and say something like “well, there is something, but I’ll lose the wellness if I mention it”. She found ways around that.
But that does seem really stupid. Part of going in for a check-up is to evaluate your current condition, and get an updated history on anything you’ve noticed (pains, growths, whatever). But that latter bit will disqualify from “wellness”. Some insurance will also disqualify it from wellness if they find something (e.g. on your bloodwork, or a routine colonoscopy). They shouldn’t be allowed to do that. One of the failings of the ACA (they could have added that to the preexisting conditions thing).
Exactly. 1poorlady had a routine colonoscopy, supposed to be wellness (per the ACA). She had no history of any problems. It was just a routine thing when someone gets to our age. They found a non-cancerous lesion. Suddenly, it’s not wellness anymore.
I get if they want to charge for a biopsy in that situation (which they did). But the rest of the procedure should still have been covered as wellness. Instead, we had to pay about 30% of the cost**.
**Some things were covered at 100%, which implies that some wellness was involved somewhere. It wasn’t clear to me how they parsed it as a matter of policy, even as I had the itemized statement. Insurance is weird.
That is a strange thing to say, If it was public health screening than you would be standing in a line at a public building. They used to have those when I played football. The Doctor would come to the school, and we would all stand in line for our public screening. Course we did get a little privacy behind a curtain.
Not really. Have you looked at the questionnaire you fill out?
From the University of Washington: This questionnaire is for patients who are eligible for Medicare and need to complete a wellness visit. It covers topics such as health assessment, psychosocial health, health and habits, function and mobility, and screening and preventive services.
Questions such as:
~ How do you rate your overall health over the last 4 weeks?
~ Do you often get the emotional support you need?
~ In the past 2 weeks, how often have you been bothered by feelings that caused you distress or interfered with your ability to get along socially with family or friends?
~ In the past 7 days, how many days did you exercise?
~ In the past 7 days, how often did you eat 3 or more servings of high fiber or whole grain foods in a day?
~ Do you always use your seat belt in the car?
~ Do you have a fire extinguisher in your home?
~ Are you afraid of falling?
~ Is there anything in your home that might make you trip or slip, and fall?
~ In your present state of health, how much difficulty do you have with managing your own finances?
Yes, intentionally opaque, frequently misbilled with both BAD economic and private health effects, AND destructive of national health. USAian national medical insurance is simply the outmost layer (created because it was the best Obama could negotiate out of a bought and paid for Congress) of a profoundly corrupt, deeply entrenched, long standing scam to skim money off of the cost of human healthcare.
Humans DO get sick. Smart governmental management would recognize the economic and (dare we speak of such an airy-fairy notion) civil benefits of reliable fundamental health care for USA’s workforce future, present, and past, and then simply budget that cost. But our political system for over a century has helped the AMA and etc., and privat4e hospital companies and etc., and medical insurance rackets and etc., bilk more profits from people who are sick by forcing them to go to war to get what was promised, and to buckle down tighter to not pay more than contracted.
BARF on all of them.
The entire conversation is as stupid as it would be to privatize municipal water facilities and then allow charging for “safe water insurance”.