Wellness

[patbz]

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 .

[software]

Can the provider rebill & resubmit?

[HULAGIRL]

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.

[Cookie2025]

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@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 .

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The Doctors Office could have given you a heads up.

[HULAGIRL]

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.

[HULAGIRL]

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.

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@software wrote:

Can the provider rebill & resubmit?

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[151949]

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

[2blonde]

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.

[Nightowlz]

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.

[Kachina624]

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?