Obamacare failing?

[disneysteve]

I did indeed have a polyp on my prior screening

Only screening tests, not done for any reason other than pure screening, count as preventative. So if you had a polyp before and they're doing a repeat test, that would be diagnostic. The same would be true for a woman who had a previous abnormal mammogram. The initial one would be a screening. The subsequent ones would be diagnostic.

The real problem is the issue of something starting out as screening and getting changed to diagnostic because something turned up. That shouldn't happen.

[DaveInPgh]

Found the e-mail from customer service regarding my last Colonoscopy. I knew they had it at age 50 in 2015.

"The preventive benefit age limit of 50-75 years (ends on 76th birthday) for the Colorectal Cancer Screening benefit was effective with 1/1/2015 date of service."

[LivingAlmostLarge]

Just got an letter from an ER visit in January. We weren't billed till now. With our HDHP there is a limit I think $250 for visit, of course we have to pay that. But then the extras we have to pay. Guess I shouldn't have had my kid's head stitched up. What was I thinking? Of course they say since we cancelled insurnace last month they weren't sure we were insured. So then I had to go back and prove we had insurance in January 2016. Yes the hoops I am now jumping through. Apparently they can't get anything straight. Thank you United Healthcare. Oh and it cost more than urgent care since they don't stitch people up. Arrgh.

Its not even the people working. They are reading off a manual. But I expect this to take the rest of the year.

I want to add in January i had my 6 year old well visit. Which is "covered" but since I asked the Dr a question about my kiddos asthma and allergies i had to pay for an office visit. After all it's two visits in 1 and only 1 is covered. Yes that's what private insurance does for you. Winner!

[GoodSteward]

I want to add in January i had my 6 year old well visit. Which is "covered" but since I asked the Dr a question about my kiddos asthma and allergies i had to pay for an office visit. After all, it's two visits in 1 and only 1 is covered. Yes that's what private insurance does for you. Winner!

Your kidding? The doctor changed the visit because you happened to ask a question? That's absurd! I understand we need medical, but I really don't like the financial/business side of it. I mean REALLY don't like it. My mom works for a private doctor and I have heard some ridiculous insurance stories.

Always remember, insurance companies are for profit first, health coverage second. They will always side with money before you if it comes down to it.

[disneysteve]

I want to add in January i had my 6 year old well visit. Which is "covered" but since I asked the Dr a question about my kiddos asthma and allergies i had to pay for an office visit.

Your kidding? The doctor changed the visit because you happened to ask a question? That's absurd!

This has become a very common problem. The insurance companies love to tout that you get an annual wellness visit, but the public simply doesn't understand what that actually means. And the government aggravated the problem by waiving the copay for the wellness visit.

Hardly a day goes by that my staff doesn't have to explain this to a patient. They come for their "wellness" visit with a list of issues they want to address. Well that isn't a wellness visit. That's a sick visit. It is billed differently and we are paid differently for performing it.

Please don't blame the doctor for that. He/she is just following the rules.

[Jluke]

Please don't blame the doctor for that. He/she is just following the rules.

I have seen this a few times now too...

So when the doctor asks if you have any questions, should you ask first if they are going to bill you? It seems like an innocent thing that a dr would want to give you that chance, but if they can bill you for it... it's almost like you go to the dr with a blank check in your hand.

For instance, I was having an issue with my eye, and the dr examined it. then the dr said oh, do you want me to pull this bent eyelash for you? $75 later.... I doubt it was medically necessary.

annual visit for my kid, we asked if his ear wax was a concern... separate charge.

Is there a way around this or is this the new norm?

I'd like to have a back and forth with the dr, but not at an added cost.

[disneysteve]

Is there a way around this or is this the new norm?

Yes, there's a way around it.

An annual wellness visit is just that. It is not a time to address any issues, illnesses, symptoms, or concerns. It is purely a preventative medicine visit.

Technically, at least for Medicare, an annual wellness visit doesn't even involve a physical examination. We have yet to start actually doing Medicare annual wellness visits because we simply don't have the time. I've heard many other doctors say the same thing.

If you have issues, illnesses, symptoms, or concerns, schedule a separate visit to address those.

There will be no copay for the wellness visit.
There will be a copay for the other visit.

[creditcardfree]

There will be no copay for the wellness visit.
There will be a copay for the other visit.

But one could save a trip and complete the whole visit at one time and pay the copay as though it was a sick visit? It's the same in the end right?

[disneysteve]

But one could save a trip and complete the whole visit at one time and pay the copay as though it was a sick visit? It's the same in the end right?

Not at all. At least not to your doctor and his/her staff. If they've scheduled you for a wellness visit, there is an expectation on their end about what that will involve and how much time will be needed. If you come along and want various other things addressed at the same time, you'll be eating into the time that is reserved for other patients. Plus there is the billing issue. We can't bill for a wellness exam and a sick visit together. It's one or the other. If we do both at the same time, we lose out on one set of charges even though we've provided both services and spent extra time with you.

One model that is starting to pop up to try and address this is to have someone other than your regular doctor do the wellness exams. For example, they may hire a nurse practitioner to come in one day a week to strictly do wellness exams. Since it wouldn't be the regular doctor, it would be easier to explain to the patient that they can't address anything other than the wellness exam at that visit. For anything else, they'd need to schedule a separate visit with the doctor.

[creditcardfree]

Not at all. At least not to your doctor and his/her staff. If they've scheduled you for a wellness visit, there is an expectation on their end about what that will involve and how much time will be needed. If you come along and want various other things addressed at the same time, you'll be eating into the time that is reserved for other patients. Plus there is the billing issue. We can't bill for a wellness exam and a sick visit together. It's one or the other. If we do both at the same time, we lose out on one set of charges even though we've provided both services and spent extra time with you.

One model that is starting to pop up to try and address this is to have someone other than your regular doctor do the wellness exams. For example, they may hire a nurse practitioner to come in one day a week to strictly do wellness exams. Since it wouldn't be the regular doctor, it would be easier to explain to the patient that they can't address anything other than the wellness exam at that visit. For anything else, they'd need to schedule a separate visit with the doctor.

Ah, I didn't realize that you had to follow a government rule that you couldn't bill for both at the same time. The time issue I understand to some degree, depending on the issue raised. It could be a simple one minute question.

I find it extremely sad that a third party gets in the middle of a doctor patient relationship. A doctor probably would have no issue spending 40 minutes with a patient if all known issues where indicated when making an appointment and a doctor was compensated for the time spent (regardless of who pays for it).

That's probably a good model for the wellness exam, although I could see some people feeling cheated on their care! I don't think I would but some would.

[disneysteve]

A doctor probably would have no issue spending 40 minutes with a patient if all known issues where indicated when making an appointment and a doctor was compensated for the time spent (regardless of who pays for it).

Theoretically that's true. The problem is that's not how the system is set up and it would be a scheduling nightmare. I'd love to be able to schedule 45 minute visits instead of 12 minute visits but we'd go broke in no time.

[LivingAlmostLarge]

I'm fine but I had no idea why we were being billed. I went in for well visit and thought I'd ask a question I had been saving. Well then we were told our visit wasn't a well check up to ask how our kid was. It was billed as a sick visit. I was just annoyed. I get that it takes time, but I guess I thought asking questions how my kid is doing with allergies and asthma might fall under 1x year visit. I guess not.

If anyone wonders why I like single payer? Maybe because there is less games. In the US you are constantly playing games with the insurance companies what they will and will not cover. How it's billed. Why it's not covered because the medical office didn't bill right. I can honestly say even the Dr office has told me they refuse payment 2x then the 3rd submission the insurance company will pay them. They say it's standard for some insurance companies to refuse payment by policy.

So you tell me how it can get worse? At least medicare doesn't refuse payment on a minimum of 2x as standard operating procedure. Other insurance companies do. And they often times when you call for a referral to a specialist will make the primary care jump through hoops to get the referral before they allow it. Delaying seeing a specialist. Also the specialist then says they had trouble getting billing for tests or something they want to do. It's a huge hassle and you have to constantly be on the insurance company or you'll be out of pocket for everything.

[DaveInPgh]

I can honestly say even the Dr office has told me they refuse payment 2x then the 3rd submission the insurance company will pay them. They say it's standard for some insurance companies to refuse payment by policy.

I have a relative that used to work for a major insurance company. She handled patient filed appeals, and she said it was their policy to deny all appeals. Only the customers that continued to fight ever got the proper compensation. It's shameful.

[GoodSteward]

I do understand a lot of why they would bill if they had to do extra work, but just to answer a question while doing the check up? That part still a nerves me that they justify it as something more. Either way, doctors offices should make it plain on the paper you fill out if you are there for a wellness visit all requested information or procedures that do not fall under the guidelines will incur a fee, or better yet the doctor should advise them they are required by law to charge to answer or do further work if a patient asks. At least give people a fair warning about it. Doing it this way appears sneaky and manipulative by implying it was just part of the visit until you are billed. It makes the doctor LOOK greedy and dishonest if you are not aware he is required to.

[Thrif-t]

I do understand a lot of why they would bill if they had to do extra work, but just to answer a question while doing the check up? That part still a nerves me that they justify it as something more. Either way, doctors offices should make it plain on the paper you fill out if you are there for a wellness visit all requested information or procedures that do not fall under the guidelines will incur a fee, or better yet the doctor should advise them they are required by law to charge to answer or do further work if a patient asks. At least give people a fair warning about it. Doing it this way appears sneaky and manipulative by implying it was just part of the visit until you are billed. It makes the doctor LOOK greedy and dishonest if you are not aware he is required to.

^ I think when you call to schedule a wellness visit the scheduling person should make the patient aware of all that before the visit!

About the only good thing, I can see a wellness visit being good for, is getting set up at a new doctors office. I'm going to a new doctor myself next week under the guise of it being a wellness visit, but I just need a new doctor in case I ever get sick. So this will be a free meet and greet.