Wellness

[Mmsfoxxie]

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.

[Mom2Dogs]

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@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?

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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!

[Mary Bailey]

I found this regarding coding Wellness:  HERE

[docsgirl]

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

[Lipstickdiva]

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. 

[MomCat]

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@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.

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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. 

[hckynut]

@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)

[novamc1]

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.

[shoesnbags]

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@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.

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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.