topic Re: Insurance surprise in Wellness

Insurance surprise

patbz — Mon, 12 Sep 2016 18:03:04 GMT

Last month I got a bill from my primary doctor with a $242 balance--after medicare b and bcbs were billed! I get a physical annually (and have for 15 plus yrs) and never had anything other than deductible. Checked with billing and they said it's because I had a physical rather than a wellness chechup. I am 72, so this is 7th year I had exactly same thing done. No one said anything so after my afternoon apt with doctor (who I just found doesn't do wellness checks, only physicals) I am changing hospitals .

Re: Insurance surprise

software — Mon, 12 Sep 2016 18:05:51 GMT

Can the provider rebill & resubmit?

Re: Insurance surprise

HULAGIRL — Mon, 12 Sep 2016 18:09:40 GMT

It seems now days you have to be so careful about the terminology that is used......I'd ask the doctor's office if it's possible to re-submit the charge as a wellness visit. I just called my doctor this morning to set up my annual appointment....I was careful to use the term "wellness check"......I'm also going to be sure it's submitted to Medicare that way. Last year I was also due for a tetnus shot so my doctor just gave it to me (which was fine with me)......I ended having to pay $75 for it because Medicare wouldn't cover it and my insurance wouldn't ether. It seems like the older you get the more complicated they make it in hopes that you'll mess up and they won't have to pay for anything.

Re: Insurance surprise

Cookie2025 — Mon, 12 Sep 2016 18:17:52 GMT

@patbz wrote:
Last month I got a bill from my primary doctor with a $242 balance--after medicare b and bcbs were billed! I get a physical annually (and have for 15 plus yrs) and never had anything other than deductible. Checked with billing and they said it's because I had a physical rather than a wellness chechup. I am 72, so this is 7th year I had exactly same thing done. No one said anything so after my afternoon apt with doctor (who I just found doesn't do wellness checks, only physicals) I am changing hospitals .

The Doctors Office could have given you a heads up.

Re: Insurance surprise

HULAGIRL — Mon, 12 Sep 2016 18:30:09 GMT

Another thing that kept happening to a friend of mine is that every year when she'd go for her wellness check, she'd end up getting a bill for the blood work that was done. Now (my doctor told me his) you cannot go before your appointment to get this done or you'll end up paying for it.....my doctor now gives me the slip when I go for my appointment and then it's covered......I know it seems stupid since it would be nice for hm to have the humbers when you show up for your appointment, but this is just one of the many things that have changed. I told my friend to not do that anymore....to wait until her appointment to get the slip for blood work.....I'm surprised her doctor wouldn't give her this info.

Re: Insurance surprise

HULAGIRL — Mon, 12 Sep 2016 18:32:04 GMT

They can and say that it was submitted under the wrong code......happened to me once with blood work.....the lab that drew the blood submitted it wrong and insurance wouldn't pay....my doctors office contacted them for me and they re-submitted it under the correct code and it was paid.

@software wrote:
Can the provider rebill & resubmit?

Re: Insurance surprise

151949 — Mon, 12 Sep 2016 19:35:52 GMT

I wonder if the doctor gets paid more if he bills it as a physical instead of a wellness visit.

Re: Insurance surprise

2blonde — Mon, 12 Sep 2016 20:05:28 GMT

The older you get, the more complicated everything gets. If we can barely stay ahead of this stuff, how are 80-year-olds supposed to do it? Our health system is a mess.

Re: Insurance surprise

Nightowlz — Mon, 12 Sep 2016 20:31:16 GMT

With our Ins we have to pay the doctor visit until our deductible is paid. 1st time with new doctor I paid the bill. My next visit I paid the bill again plus Ins paid in full so I owed nothing & waited 3 months for a refund. I found out the 2nd visit was coded for Wellness but the 1st visit was not. I only see the doctor once per year to have thyroid tests & he runs the normal cmp, cbc, lipid panel & A1C. I would think this would be a wellness visit but they only charged me that way 1 time. I paid for all my other doctor visits. The doctor also gets paid more in total coding it as Wellness than coding how they coded all my other visits. Makes no sense to me since you would think they would file where they receive the most money.

I don't have the patience to deal with it so I just pay the bill.

Re: Insurance surprise

Kachina624 — Mon, 12 Sep 2016 20:33:41 GMT

The doctors office undoubtedly coded it wrong. Insurance payments now seem to totally contingent on the accuracy of the coding. What's the difference between a physical and a wellness check?

Re: Insurance surprise

Mmsfoxxie — Tue, 13 Sep 2016 00:59:16 GMT

All I know @Kachina624 is that when I called my doctor, new to Medicare and asked for a physical, he told me I needed to get a wellness check, not a physical because Medicare won't pay for my physical. I don't know if they wouldn't pay because I one the year before or what. If I had it, I didn't have Medicare, though.

Re: Insurance surprise

Mom2Dogs — Tue, 13 Sep 2016 01:21:26 GMT

@Kachina624 wrote:
The doctors office undoubtedly coded it wrong. Insurance payments now seem to totally contingent on the accuracy of the coding. What's the difference between a physical and a wellness check?

My dh had a physical a few years ago, I specifically said wellness, but they paid no attention, the visit cost $100.00 I called and complained but they would not chage the code. Then about 1 year later....I got a refund in the mail!

Re: Insurance surprise

Mary Bailey — Tue, 13 Sep 2016 09:01:41 GMT

I found this regarding coding Wellness: HERE

Re: Insurance surprise

docsgirl — Tue, 13 Sep 2016 09:25:14 GMT

HULA,

My doctor gives me a written prescription for a full panel of blood work to be done prior to my wellness exam. When I see him, he sits down and goes over all the results with me. I have never been billed for this blood work. It makes more sense for him to have the results prior to the exam just in case there is something that needs to be addressed.

I'm 70 years of age and my friend and I were just discussing how they seem to making things more complicated for the seniors. docsgirl

Re: Insurance surprise

Lipstickdiva — Tue, 13 Sep 2016 16:03:16 GMT

I'm not on medicare but I too get bloodwork done prior to my annual doctor visit. She will not see me unless I've had that done and she has the results.

However, I found out last year that my DH's insurance will NOT pay for cholestrol testing for anyone on the policy other than the employee. I got hit with a $100.00+ charge for that part of my bloodwork.

Re: Insurance surprise

MomCat — Tue, 13 Sep 2016 18:01:57 GMT

@2blonde wrote:
The older you get, the more complicated everything gets. If we can barely stay ahead of this stuff, how are 80-year-olds supposed to do it? Our health system is a mess.

Yes it is. I'm lucky my doc ofc is trying to keep up with all the changes that are designed to take away as many benefits as possible from us. Makes me angry that insurance companies ever went along with designing this monster of a mess.

Re: Insurance surprise

hckynut — Tue, 13 Sep 2016 18:32:53 GMT

@HULAGIRL

I have mentioned many times on this forum about how many thousands of $$$ my wife as saved me over the years. Her jobs included both Medical and Dental Claims Analyst from doctors and dentists offices.

Over her close to working almost exclusively with the claims submitted by these offices. How many were "coded wrong" led me to believe it was 1 of 2 things, or both. Office staff that did not effectively understand the coding, or deliberately put in the wrong code(s), for differing reasons.

Most doctors have the ability to legally use different codes for pretty much the same examination. Many choose to code them differently for a myriad of different reasons, most of which unfortunately, have to do with $$$$.

With all the Medical EOB forms I have been sent since 2002, when my serious health issues began, that would number well over a thousand of them. The number of them that were coded wrong from doctors offices/hospitals, and including a dentist and an Oral Surgeon, were way too many to qualify as a legitimate mistake.

I suggest anyone with a doubt about the cost of any doctors office exam, question if it could be coded differently, when the exams could easily be legally be coded differently, and coincide with less cost to the patient.

Even our vet has coding for exactly the same type of exams for our felines, the cost for 1 code is much more than the other that is available. The age of our felines does factor into which code is used. Get a new office staff worker and there have been times we have told them this was a "Senior Feline Exam", which costs less because a bit less is done in the exam. If in doubt? Ask.

hckynut(john)

Re: Insurance surprise

novamc1 — Wed, 14 Sep 2016 01:12:52 GMT

I don't have any known medical issues, so I skipped the last one or two Medicare "wellness exams". Finally went a couple months ago.

I knew patient-requested tests without evidence of a medical issue weren't covered, but I was curious about my status in certain areas and asked for a couple of blood tests (knowing Medicare wouldn't pay but Blue Cross/Blue Shield would). I was given a disclosure form to sign indicating that Medicare would not pay for the tests and I would be responsible.

Blue Cross paid the entire cost of the tests, and I did not have to pay a dime, even a copay up front. The difference between my experience and those of others writing here seems to be that (1) I already knew the limitations of a "Medicare wellness exam" , and (2) I was given a form to sign, obligating me to pay for the blood work that I requested if a secondary insurer would not.

Medicare info is readily available on the internet, if you don't get the book that Medicare sends out detailing what is covered. Prime thing to remember is that a "complete physical exam" is not a Medicare "wellness exam".

One other thing that might bear mentioning.......doc recommended a new pneumonia shot, so I agreed to that. When Blue Cross had settled the claim from that visit, I couldn't figure out what the two awfully high charges were on the statement I received. Blue Cross informed me that one of the charges was for the ingredients of the shot, and the other high charge was for the administration of the shot. I was impressed by how much a few seonds of inserting a needle was worth! Yikes.

Re: Insurance surprise

shoesnbags — Fri, 16 Sep 2016 22:14:16 GMT

@HULAGIRL wrote:
Another thing that kept happening to a friend of mine is that every year when she'd go for her wellness check, she'd end up getting a bill for the blood work that was done. Now (my doctor told me his) you cannot go before your appointment to get this done or you'll end up paying for it.....my doctor now gives me the slip when I go for my appointment and then it's covered......I know it seems stupid since it would be nice for hm to have the humbers when you show up for your appointment, but this is just one of the many things that have changed. I told my friend to not do that anymore....to wait until her appointment to get the slip for blood work.....I'm surprised her doctor wouldn't give her this info.

Uh oh. This is exactly what I did this year. For exactly the reason you stated. I'm surprised my doctor's nurse assistant didn't say anything, because she is very good with insurance related issues. Could this be something that varies according to your insurance? Since my appointment was just 10 days ago, I don't know yet what will or won't be paid by Medicare and insurance co.