Medical Billing Question - Double Billed for Preventative Visit?

[disneychrista]

Actually I’m in the same boat as mrs pete. One polyp the first time and that branded me as having a history.

So your was also billed as diagnostic and not preventative? I too am on the 5 year plan because they remove two polyps last year when I had my first one. Never thought they would no longer consider it preventative now. I’ve had things found during other routine screenings (pap, mammogram) and those screenings are still considered preventative.

 

[bluecruiser]

I had some polyps found (non-cancerous) at my first colonoscopy, but haven't been billed for any of the regular colonoscopies since then. I'm at a slightly increased risk of colon cancer due to past endometrial cancer (almost 30 years ago), so you would think I'd fall into the same category as @MrsPete. But insurance continues to cover it.

 

[Music City Mama]

- Essentially this means that the people who need the services most have to pay more than those who are just being checked.
- It's not just colonoscopies: it's also true for mammograms and other screenings. How can insurance get away with this?

My husband can relate to this. His first preventative at 50 resulted in a benign polyp which now puts him at every 5 years, so no more preventative (covered at 100% by insurance) colonoscopies for him -- all diagnostic.

I'm supposed to get a free screening mammogram every year, but because they always want to look at something more in depth either by diagnostic mammogram, ultrasound or both, I'm only ever cleared for that regular screening every 2-3 years, and then the process starts all over again.

Like you, I'm glad that they're paying attention and are checking everything, it's just the insurance thing that's maddening.

 

[LuvOrlando]

So sorry this happened to you, I know the Drs need to be paid but this sort of thing seems exploitative & decidedly uncool. It is tough enough to get everyone in to be seen so this sort of strategy will not encourage patient compliance or follow up, what a buffoon the Dr is to do this to you OP

Just because you can do a thing doesn't mean you should do the thing, maybe it is legal but it is reprehensible.

These visits should come with a consumer warning in the waiting room, "If you answer my question, 'How are you?' truthfully on a well visit, there will be a fee."

 

[kymom99]

That explains why my colonoscopy cost me a few hundred this time. My polyps this second time were precancerous so I’m on the 3 year plan.

 

[mamamary]

This has happened to me also. If anything is brought up outside of the annual well visit it will be a different code. My last two annuals i didn’t bring anything extra up - there wasn’t anything- and they still billed me. So I call and complain and the billing office eventually gets around to taking the charge off my account. It’s super frustrating. It’s almost like they do it in hopes that people just going ahead and pay it.

 

[SandyinMonterey]

At my daughter's doctor's office, when checking in for her yearly physical they give me a piece of paper that basically says once I bring up something (cold, meds, an issue she's been having, etc.) anything out of lines of a yearly well exam visit, it's no longer a well exam visit.

 

[Pooh2]

I was charged for an additional visit ($366) for them to renew my asthma prescription at my wellness check-up.
No testing or discussion, just too click the "send to the pharmacy for renewal" button.

 

[tzolkin]

My first thought was that maybe being up the anxiety invalidated the well exam but sounds like they want to double dip, which doesn’t sound right at all. They either charge for the office visit or charge for the well visit. Not both.

Unfortunately, this is now fairly standard. It has been happening for well over a decade (I remember first encountering this when I lived in a different state and that was over 10 years ago). I feel like back then it was up to the doctor's discretion whether they felt the extra time was worth billing for, but it has now become the norm to bill for both an office visit and well visit for the same encounter.

I have only once successfully had them remove the charge for the second visit.

These visits should come with a consumer warning in the waiting room, "If you answer my question, 'How are you?' truthfully on a well visit, there will be a fee."

I recently took my son for a well visit and went to one myself. At both practices, there was a form on the clipboard as well as signs posted on the walls letting you know that if you discussed any issues beyond the scope of the annual physical you would be charged for an office visit as well. I assume patients must have started complaining about their bills.

 

[Moliphino]

I recently took my son for a well visit and went to one myself. At both practices, there was a form on the clipboard as well as signs posted on the walls letting you know that if you discussed any issues beyond the scope of the annual physical you would be charged for an office visit as well. I assume patients must have started complaining about their bills.

Genuine question, not trying to be snarky. What is within the scope of an annual physical?

 

[LuvOrlando]

Thinking on this, how does a preventative visit work if you can't say anything that has been bothering you but hasn't been diagnosed yet?

I mean, in a quite literal sense, a preventative visit should be to prevent a small thing from getting bigger and more expensive but you can't say anything...

If a preventative visit is not meant to prevent a thing, then in a very literal word meaning sense, what is the purpose? Is it just so prescriptions aren't interrupted and even this isn't a great idea since maybe doses need to be changed and a Dr wouldn't know that if you just nod and smile at every question?

TBH I can't even remember my last well visit, people with chronic stuff are never "well" enough to just pass through so the people who would need one most have no use for it...

Riddle me this, Riddle me that made my head hurt :/

 

[Mackenzie Click-Mickelson]

- Essentially this means that the people who need the services most have to pay more than those who are just being checked.
- It's not just colonoscopies: it's also true for mammograms and other screenings. How can insurance get away with this?

I don't exactly agree with the practice but if preventative care carried a cost no one would go and then you wouldn't even get to the point of diagnostic. Franky as I mentioned in another thread months ago because we're seeing colon cancer in increasing numbers in 30s think how much more we would catch if preventative tests were covered by insurance for more people?

 

[Mackenzie Click-Mickelson]

I wouldn't say it's a one size fits all here. In the OP's case I can see where anxiety is no longer about your normal once a year wellness exam. That takes on a specialized arena. And instead of it being about blood work, examining the patient physically now we're getting into what could be its own doctor's visit OR one where a patient would seek out a different doctor than a GP.

Also not to get too off track but a doctor shouldn't just prescribe someone anxiety meds without actually going over a lot regarding why the anxiety is there, what situations is it coming up, etc which is normally going to be under a behavioral therapist not your normal doctor. A doctor can help figure out if there would be any interactions based on the patient's medical history but the OP states "I would like to try medication to help manage my anxiety" which is pretty far left field in terms of what their normal annual exam is about.

 

[DisneylandFreak2013]

Thank you, all! I called the billing for the group that my doctor is part of. It said I owed zero and had no bill. I then called my insurance, because that is where I had my EOB and statement that I owed my doctor. After speaking with them, they said they saw on their end that there was an issue and a mischarge and it was being fixed so that I would owe nothing. Great news, because I was sure I would be charged for an office visit but not both preventative and office!

 

[DisneylandFreak2013]

I wouldn't say it's a one size fits all here. In the OP's case I can see where anxiety is no longer about your normal once a year wellness exam. That takes on a specialized arena. And instead of it being about blood work, examining the patient physically now we're getting into what could be its own doctor's visit OR one where a patient would seek out a different doctor than a GP.

Also not to get too off track but a doctor shouldn't just prescribe someone anxiety meds without actually going over a lot regarding why the anxiety is there, what situations is it coming up, etc which is normally going to be under a behavioral therapist not your normal doctor. A doctor can help figure out if there would be any interactions based on the patient's medical history but the OP states "I would like to try medication to help manage my anxiety" which is pretty far left field in terms of what their normal annual exam is about.

I would not consider bringing up an issue that she knows about being left field. She knows my family medical history of anxiety, my medical history, and is a very competent woman. Prescribing 25mg of Zoloft is well within her purview, especially with my history and very high stress career. I've managed anxiety in other ways, now I am at the point where medication is the next step.

I'm sorry that you have not had experience with qualified medical practitioners who feel comfortable prescribing medication that treats the whole patient. I am lucky to live in an area with really great doctors that listen and treat, it is unfortunate that not everyone has that.

 

[DisneylandFreak2013]

Thinking on this, how does a preventative visit work if you can't say anything that has been bothering you but hasn't been diagnosed yet?

I mean, in a quite literal sense, a preventative visit should be to prevent a small thing from getting bigger and more expensive but you can't say anything...

If a preventative visit is not meant to prevent a thing, then in a very literal word meaning sense, what is the purpose? Is it just so prescriptions aren't interrupted and even this isn't a great idea since maybe doses need to be changed and a Dr wouldn't know that if you just nod and smile at every question?

TBH I can't even remember my last well visit, people with chronic stuff are never "well" enough to just pass through so the people who would need one most have no use for it...

Riddle me this, Riddle me that made my head hurt :/

100% agree with you. Preventative care visits should do just that - prevent and identify before problems get worse. Like with my anxiety, a very low dose medication has helped tremendously. I was pretty reluctant, but am so glad that I tried it. Addressing it now will help keep it manageable before it gets worse.

 

[Mackenzie Click-Mickelson]

I would not consider bringing up an issue that she knows about being left field. She knows my family medical history of anxiety, my medical history, and is a very competent woman. Prescribing 25mg of Zoloft is well within her purview, especially with my history and very high stress career. I've managed anxiety in other ways, now I am at the point where medication is the next step.

I'm sorry that you have not had experience with qualified medical practitioners who feel comfortable prescribing medication that treats the whole patient. I am lucky to live in an area with really great doctors that listen and treat, it is unfortunate that not everyone has that.

Anxiety discussion is left field for a once a year check up that is most commonly used for very basic things like weight, bloodwork, blood pressure, brief overview of stuff. And most especially if you're asking to be put on meds and you haven't been on any prescribed by this doc for that issue before. Are you in therapy? Does your doctor know this? I'm not really asking that's your biz, I was going by your OP when I made my comment.

It has nothing to do with a doc feeling comfortable about prescribing meds and everything to do with just doing it without any other stuff going on. That is exactly why we have issues that we do now with medications. My sister was diagnosed with clinical depression and was prescribed Prozac but not without first going to counseling (where she was diagnosed with depression) and being in counseling continuously. With her doctor she worked on a different medication because Prozac increased her blood pressure, that I would def. consider a doctor's prevue but just "hey give me some Zoloft I wanna see if it works"? And you have a high stress career so your doc just hands over Zoloft?

We have specialized people for reasons and it can often mean going to multiple ones to treat things as well as work collaboratively. Yes I would consider bringing up asking for medication to treat anxiety during a once a year annual exam to be out of left field regardless of past knowledge your doc may have. As someone else mentioned that does take extra time and any doc who is just writing up meds without actually spending a lot more time to discuss things may be a doc you're comfortable with but doesn't mean they are actually doing a thorough job. Heck getting on one of the most basic birth control pills took a lot more than it apparently took for you to get on Zoloft!

 

[LuvOrlando]

Thank you, all! I called the billing for the group that my doctor is part of. It said I owed zero and had no bill. I then called my insurance, because that is where I had my EOB and statement that I owed my doctor. After speaking with them, they said they saw on their end that there was an issue and a mischarge and it was being fixed so that I would owe nothing. Great news, because I was sure I would be charged for an office visit but not both preventative and office!

This is very good news!

 

[MrsPete]

So sorry this happened to you, I know the Drs need to be paid but this sort of thing seems exploitative & decidedly uncool. It is tough enough to get everyone in to be seen so this sort of strategy will not encourage patient compliance or follow up, what a buffoon the Dr is to do this to you OP

Just because you can do a thing doesn't mean you should do the thing, maybe it is legal but it is reprehensible.

Well stated.

That explains why my colonoscopy cost me a few hundred this time. My polyps this second time were precancerous so I’m on the 3 year plan.

Two thoughts:
- My polyps were benign, so that explains why I'm on the 5-year plan ... while you're forced to go every 3 years.
- You paid a couple hundred. I paid about $1300. What your experience tells me is that I have four years to find a location that charges less.

Genuine question, not trying to be snarky. What is within the scope of an annual physical?

I'd very much like this answer!

 

[Moliphino]

I'd very much like this answer!

I know, right? I haven't been to a primary care in ages, but at my regular eye exam, dental exam, gyn exam they always ask during the appointment if I have any questions or concerns. What can you bring up then without being out of the scope of your annual exam?