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Skipping the Yearly Wellness visit?

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  • #16
    Originally posted by LuckyRobin View Post
    I don't know how it can be a wellness "exam" if there is no examination.
    A lot of it can be seen as semantics but it's an important distinction. You won't typically see the words "wellness exam". You will see "wellness visit". They do that purposely because a true wellness visit doesn't really involve a physical examination. It's all about addressing preventative measures. It is not the same thing as an annual physical, which is what people are used to having.

    There is an effort in the medical field to shift more focus to prevention rather than a disease-focused approach (something us doctors have been promoting for years). It is a lot more cost-effective to prevent illness than to treat illness, or at least to treat something early on rather than at a later stage. The reimbursement model is starting to reflect this by compensating doctors more for meeting certain quality metrics - rate of colon cancer screening, rate of mammograms, counseling on smoking and obesity, etc. So over the coming months and years, you're going to see this shift when you see your family doctor as that model evolves.
    Steve

    * Despite the high cost of living, it remains very popular.
    * Why should I pay for my daughter's education when she already knows everything?
    * There are no shortcuts to anywhere worth going.

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    • #17
      Thrif-t
      $ Saving HS Senior

      Join Date: Jun 2006
      Forum Posts: 252
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      Yes you are right if you ask a question it becomes a sick visit and you get charged. I made that mistake a few years ago when I went in for a visit asked a question about my neck, didn't need any PT or drugs but we discussed it and I had to pay the office co pay


      This is the jist of it DisneySteve. . .and I get it Wellness to Sickness is kind of a continuum. Mention one ache or pain and does it automatically become a sickness visit?

      Yes, in a way it does.

      I am not pointing fingers. . .as the resident chiropractic physician here, i would admit we kind of are very bad at separating that continuum and yes, this was an issue before Obamacare but I guess Obamacare's sales pitch, or part of it, was this free "Wellness visit."

      And many people are wise to the billing discrepancy.

      Or at least should be before visiting the family doc and just perhaps schedule a different visit to mention the ache or pain, if the deductible or copay is an issue.

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      • #18
        I wouldn't think it to be crass or inappropriate in any way to tell your doctor that this just needs to be a wellness visit---if we discuss anything that wouldn't be covered under the visit, please let me know because I don't want to pay / cannot afford / to be billed for a regular office visit right now. It sucks, but this is the healthcare system we've come up with in the last 50 years.
        I think more what's happening is just being aware that the Wellness visit is a screen and only a screen which leads to diagnostic testing, not addressing or talking about your symptoms?

        I am not sure what's going on the patient's heads to be honest. Or at the family doc's office. I know one family doc hired a nurse practitioner to do only the Medicare Wellness visit and bills out her for that. They call them up to come 1x/year for that, indicated it was mandatory for practice "membership" and were complaining about the solicitation but I actually think it's not necessarily a bad idea.

        I guess they talked about their aches and pains and then it turned into more? I'll ask my office assistant. . .she gossips more with the Medicare aged people.

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        • #19
          Well, I just asked my assistant and lol. . .well, you know how that goes.

          Her gripe was, with her peers (Medicare age), that she was going 1x/month anyway for this or that (BP, diabetes, etc) so now they were told they have to go in for a Wellness visit in addition to their monthly. Well, actually, I DO kind of get the family doc's take on that. . .it's more broad and less focused. It creates a more comprehensive plan of management (at least theoretically)

          This of course, is separate from the Obamacare issue. . .if I go in and say (actually this would be truthful), I am not sleeping well lately. . .well. . .golly gee whiz, Scanner, you may have apnea. . .let's have you go see this Healthcare Cash Cow - Sleep Apnea testing. (just an example, that's not to throw any family doc under the bus). Oh, ignore my recs, will you? We'll see about that!

          I think we'd all say it's 50/50 odds straight up that would happen. And for various reasons, cover butts, everything is medicalized, institute compliance, etc.

          Yeah, I have to admit. . .there are some things in Pandora's Box I may not let the doc in on.

          At that point, if I admit I am not sleeping well, do I know get coded as a disease visit of "Insomnia" as diagnosis or is it a wellness visit? Not sure. A case could be made either way.

          It is a shame it's all come to this - micromanaging the exchange between doctor and patient. I deal with the same thing with maintenance care.

          Oh well, I just wanted to hear what was floating out there.

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          • #20
            I believe that part of the wellness visit is discussing any health concerns with your doctor, so that the doctor can advise you on whether you need additional testing or what you experience is completely normal, or suggest changes to your diet, lifestyle, etc. I agree that any problem that needs immediate attention warrants a special appointment, separate from the annual wellness visit; however, I should be able to ask my doctor questions about my health condition as part of the wellness visit without being concerned about getting a bill for a sick visit.

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            • #21
              Originally posted by safari View Post
              I believe that part of the wellness visit is discussing any health concerns with your doctor, so that the doctor can advise you on whether you need additional testing or what you experience is completely normal, or suggest changes to your diet, lifestyle, etc. I agree that any problem that needs immediate attention warrants a special appointment, separate from the annual wellness visit; however, I should be able to ask my doctor questions about my health condition as part of the wellness visit without being concerned about getting a bill for a sick visit.
              This And I know I sound like I'm complaining, I'm really not I was just thrown for a loop when asked to pay money I wasn't expecting to pay. And to add insult to injury this doc only takes cash or checks. I'm not one to walk around with a lot of extra cash so good thing I had my check book. And now that I know the rules I won't be caught off guard again. But I'd just think discussing future potential problems, not diagnosing not treating just talking about a family history problem and how to avoid it, well to me that is preventative and the whole reason for the dang wellness check to begin with.

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              • #22
                Originally posted by safari View Post
                I believe that part of the wellness visit is discussing any health concerns with your doctor
                That's exactly where the confusion is coming in - for patients and doctors alike.

                Discussing specific health concerns with your doctor is NOT a wellness visit.

                The insurance companies have done a crappy job of explaining this and educating patients. All the patients hear is "I can go see my doctor for free," so they make a list of every ache or pain or pimple that they have so they can go in and get everything addressed and treated during that free visit. If the doctor actually addresses those concerns, he won't have any time to do the things that are supposed to be done during the wellness visit. You simply can't do both at one time. It isn't possible. I understand why patients find that frustrating but there's really no other way to do it.
                Steve

                * Despite the high cost of living, it remains very popular.
                * Why should I pay for my daughter's education when she already knows everything?
                * There are no shortcuts to anywhere worth going.

                Comment


                • #23
                  Originally posted by disneysteve View Post
                  The insurance companies have done a crappy job of explaining this and educating patients.
                  Yes! Educating is the key. I would say it could also fall on doctor's, front desk workers, and nurses too, however. If you know how the system works, it seems a fiduciary duty to explain to your customers.
                  My other blog is Your Organized Friend.

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                  • #24
                    This conversation has been useful - I had no idea there was a difference between an annual physical and an annual "wellness" visit, being new to HMO's and never having done either one. I've always just gone when I'm sick, which is often enough to see my doctor regularly. My HMO covers one free "adult annual visit" - I guess I'll find out what that means when I get there.

                    I have a complete physical scheduled. I'd rather pay and not waste my time by needing to go back twice.
                    Last edited by HappySaver; 03-18-2015, 06:19 AM.

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                    • #25
                      I think a lot of this depends on your insurance, and what fits into their definition of "wellness visit" or "wellness exam". My insurance, for example, covers an annual physical, which includes "height, weight, BMI, blood pressure, history, anticipatory guidance, education regarding risk reduction, and psychosocial/behavioral assessment", as well as labs for cholesterol and blood sugar, and a mammogram/OB/GYN exam for me; my husband's employer gives us a credit against our premiums if we both undergo this annual physical/exam.

                      The ACA lists specific preventive care measures for which you cannot be charged; this includes blood pressure measurement, counseling on diet, weight loss, alcohol and tobacco use, depression, and pregnancy issues, and may include cholesterol, diabetes, and cancer screening, among other things.



                      Medicare has its own definition of a "wellness visit", which includes a health risk assessment, blood pressure, review of medications, and a "personalized preventive plan".

                      Stay ahead of your health with preventive visit coverage. Schedule "Welcome to Medicare" visits, yearly wellness exams, more under Medicare Part B.

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                      • #26
                        Originally posted by Scanner View Post
                        Well, I just asked my assistant and lol. . .well, you know how that goes.

                        Her gripe was, with her peers (Medicare age), that she was going 1x/month anyway for this or that (BP, diabetes, etc) so now they were told they have to go in for a Wellness visit in addition to their monthly. Well, actually, I DO kind of get the family doc's take on that. . .it's more broad and less focused. It creates a more comprehensive plan of management (at least theoretically)

                        This of course, is separate from the Obamacare issue. . .if I go in and say (actually this would be truthful), I am not sleeping well lately. . .well. . .golly gee whiz, Scanner, you may have apnea. . .let's have you go see this Healthcare Cash Cow - Sleep Apnea testing. (just an example, that's not to throw any family doc under the bus). Oh, ignore my recs, will you? We'll see about that!

                        I think we'd all say it's 50/50 odds straight up that would happen. And for various reasons, cover butts, everything is medicalized, institute compliance, etc.

                        Yeah, I have to admit. . .there are some things in Pandora's Box I may not let the doc in on.

                        At that point, if I admit I am not sleeping well, do I know get coded as a disease visit of "Insomnia" as diagnosis or is it a wellness visit? Not sure. A case could be made either way.

                        It is a shame it's all come to this - micromanaging the exchange between doctor and patient. I deal with the same thing with maintenance care.

                        Oh well, I just wanted to hear what was floating out there.
                        DS can probably tell you what he'd tell his patients. In my own experience, I have a pretty good doc that tells me I need to schedule a separate visit to look at something if it's not falling within the wellness exam that IS covered through my HSA. He won't automatically upcode the visit and not tell me, but there probably are providers that will do that, or wouldn't take the time to explain the difference.

                        This is why I'd much prefer many of the positive aspects of the Canadian healthcare system over ours here in the US.

                        Also, just personal experience, there's little value in witholding health information from your doctor, if that's what you meant by your "Pandora's Box" comment. Docs don't need to be your crying shoulder, but I'm also of the belief that there shouldn't be any shame in telling your doc about things that could affect your health or the health of others!
                        History will judge the complicit.

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                        • #27
                          Also, just personal experience, there's little value in witholding health information from your doctor, if that's what you meant by your "Pandora's Box" comment. Docs don't need to be your crying shoulder, but I'm also of the belief that there shouldn't be any shame in telling your doc about things that could affect your health or the health of others!


                          Oh, definitely. Sometimes, with my extensive healthcare background and knowing the system, I am my own worst enemy. It's not shame as much as now if I mention I have insomnia. . .well. . .gee whiz, there are 87.5 causes of insomnia. . .let's work that up.

                          You mention this or that and you can be put on a merry-go-round. I just see it too much. But I have to agree - sometimes you just got be a carnival-goer I guess and go on a few of the rides, I suppose.

                          I have seen many of my colleagues DIE from avoiding the doctor. . .one was my mentor's wife - didn't believe in PAP smears - got cervical cancer that metastasized to the brain. The other was a colleague. . .got prosate cancer that went mets to the spine.

                          I'm trying to strike that healthy balance of "just enough allopathy."

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