Doctor billing question?

[Wheres Toto]

I rarely go to my doctor.  Occasional (not yearly) physicals, allergy issues, etc.  I have an appointment today because I hurt my back and my hand keeps tingling and work is making me get a doctor's note to change my keyboard/mouse set up to something better.

 

When I called, they told me I had an outstanding balance of around $160 from my last visit, which was a wellness visit.  My insurance covers wellness 100% with no deductible, an agreed upon payment with participating doctors (pretty much standard).  The charges were because we discussed some things at that visit that would be considered ailments (perimenopause and vitamin D deficiency).  They said as soon as any ailments are discussed, it is billed as a sick visit.

 

Has anyone heard of this before?  I've never had that happen.  My ob/gyn charges my well visits as well visits regardless of what we discuss.  If there is follow-up, those are usually charged differently, but not discussions at the well visit.

 

I really want to find a new doctor but need to do it when I'm not sick or in pain.

 

[Aiden]

That's ridiculous. The purpose of a well visit is to screen for potentially developing problems. How is that supposed to happen if as soon as you mention a problem, it's no longer a well visit? That would annoy me to no end, and I would find a new doctor ASAP ... but in your situation, I'd probably bow to the practical reality and get what I needed from him first.

[melmichigan]

We cannot discuss anything other than the specific values needed to fill out our healthy living screening forms on a well visit, otherwise it becomes a regular visit and we will be billed as such.  This is specified by our insurance and the physicians office has a notice to that effect on the back of the exam room doors to remind patients.  The visit can only be preventative in nature.  Technically they can't even order additional labs, beyond those for the well visit, without incurring an additional fee.  This is pretty standard across all the insurance companies that my DH's company offers.  It's an insurance dictate, not a physician dictate.

 

Edited January 21, 2016 by melmichigan

[SebastianCat]

I have had the exact same experience.   Because we discuss my hypothyroidism at each visit, and thyroid meds are prescribed, I no longer have "well" visits.   They are all coded as "follow up" visits.

 

The pediatricians' office that my kids see has coded all of their visits as "well" visits, but neither of them have any chronic medical conditions.

[Erica in OR]

That happened to me at a gyn annual checkup once. I was miffed because I'd specifically saved a concern until that appointment. If I'd known I would get charged for two visits, I would have made two visits, to get the extra time with the dr.

 

Erica in OR

[cintinative]

I am sharing your confusion. So, the point of the well visit is to always be well? Or to keep you well? Because if the former, what is the point of even going?  I imagine every time I go for a well check there is something "new" because I am getting older and my body is changing. So yes to perimenopause and questions about that. I have been billed for things my insurance didn't consider preventative (e.g. Vitamin D test) but I have never had the "well check" visit billed as a regular visit just because something was found.  I am confused on this also.

[melmichigan]

I am sharing your confusion. So, the point of the well visit is to always be well? Or to keep you well? Because if the former, what is the point of even going?  I imagine every time I go for a well check there is something "new" because I am getting older and my body is changing. So yes to perimenopause and questions about that. I have been billed for things my insurance didn't consider preventative (e.g. Vitamin D test) but I have never had the "well check" visit billed as a regular visit just because something was found.  I am confused on this also.

I think this is becoming the norm because many of us have to have an annual physical screening, "well visit" in order to maintain our insurance.  It's a yearly requirement.

 

I have three months a year to have a set of specific labs done, and a "well visit" with my primary care physician.  He is then required to send a third party a screening form based on my results. Then we have healthy living requirements based on our values.

Edited January 21, 2016 by melmichigan

[Word Nerd]

I think that's becoming a common policy.

[Wheres Toto]

I know it's not my insurance because it's only this one doctor, and I checked when it first happened to dh.  I thought dh missed something, like he booked his appointment wrong.   Whoops, I guess I can't blame him anymore.   The doctor is switching to a concierge type practice and I think he does this to those long-term patients that haven't switched over.  

 

My kids all go to the pediatrician every year, my oldest goes gyn twice a  year, I go gyn once a  year - for preventative and none of us have ever been charged extra.  My gyn visits especially are going over all kinds of problems, I've had ultrasounds scheduled as follow-ups but still not charged for the visit where they "discovered" the issue requiring follow-up. 

 

I can't think of how you would keep it a well visit.   :confused1:   Don't discuss anything?  Hope the doctor doesn't find anything?  What if you have a weight problem?  Automatically a sick visit?  

 

 

[teachermom2834]

This has been our experience as well. My dr. Has been apologizing for it and making us sign paperwork saying we understand for a couple years. I have had two visits booked back to back before which seemed to eliminate the problem.

 

Definitely doesn't seem to be my dr. She seems to feel bad about it and dislike the policy.

Edited January 21, 2016 by teachermom2834

[SparklyUnicorn]

This happened to my husband once.  Except the doctor billed it as both a wellness and a sickness visit.  We fought it and the doctor didn't win. 

 

Anyhow, why tell you now?  Why not send you a bill?  That's ridiculous.

 

 

[zoobie]

That's weird. Why wait on the bill? If they'd let you know immediately, you could follow up with insurance and get it processed correctly. Waiting until now is as ridiculous as parsing out tiny issues to mega bill.

 

But, if your hand is tingling from work, work needs to send you to the doctor. It shouldn't go under your health insurance. (Assuming you're in the US.)

[Wheres Toto]

I'm in the US.  Not sure it's entirely work related although it probably is.   It started when I was working at home for a couple weeks - less than ideal set-up and it was an extremely busy time so lots of mouse work and typing.    If there is any follow-up beyond getting my note for a new set-up, I"ll look into it as a work-related injury.

[carriede]

Yep. That's why when I take the kids to their well child visits, I don't ask any questions. Everyone is happy and healthy!

 

The one time I did, I had asked about an mild exema rash that we couldn't quite figure the cause of. Doc said to just wait it out and see of it got worse. But then I had to pay for a "sick" visit. Lovely.

[Wheres Toto]

Some of these stories are ridiculous.  A couple words about a possible issue should not be charged extra.  I can see if tests are ordered, maybe.  But a quick comment?  Absurd.

 

[SparklyUnicorn]

The doc asked my husband during the well exam if he had any issues.  My husband said he gets heartburn a lot.  The doctor told him to cut out soda.  That was it.  He billed double because he considered that a problem focused visit on top of a well visit.  As I said though, that didn't hold up to arbitration.

 

 

 

 

[hepatica]

I have had the exact same experience. Anything outside answering the wellness form questions is considered an added office visit. And, even if you answer the questions and that precipitates discussion (in my case I was not sleeping well, my DD was preparing for surgery so duh) it is coded as an office visit. Guess I wouldn't mind so much if they informed me on the spot and if they actually gave me the extra time of an added office visit. I have concluded it is impossible to get a free wellness exam. 

 

Our pediatrician, on the other hand, is careful to code physicals as just physicals, so we can ask whatever questions we want. But she works alone in a single office. Thank goodness for that. 

[StephanieZ]

FWIW, we have yet to run into this issue, despite the fact that we nearly always have questions and issues at well visits. Last week, at a kid well visit, we asked about three separate not-wellness issues. Advice/guidance/follow up care was advised for all issues. Honestly, nearly every wellness visit for us includes at least one or more "issues". 

 

I'd be pretty irked if I got a surprise bill after the fact. Seems like they need to warn you. 

 

FWIW, my gut says this is a corporate/practice decision to maximize insurance reimbursements. I wouldn't personally change doctors about this issue, but I would be irritated.

 

FWIW, my dh is a vet, and at least half his wellness exams have issues. His fee structure used to be cheaper for wellness exams than sick exams. He would *never* up-charge "wellness" visits even though people clearly took advantage (and he was "supposed to" and he owns the practice) . . . We finally ended the issue by changing to an exam fee that is the same for both wellness and sick exams. Problem solved, lol. So, anyway, I feel sorry for the Drs working with insurance and trying to make a living. Sucks to be them, and sucks to be the patients caught in the middle. 

[Guest]

It's common and just happened to me two weeks ago. Annoying.

[Joker]

We don't even do actual well visits anymore (except for me at the gyn). If we have an issue, we schedule an appointment and go over everything. Often there is blood work and/or other tests.

 

Sometimes they bill it as a well visit, though. That just happened with both dds and so we had no out of pocket expense for the visit but I didn't schedule it as a well visit. We went over a few things, they both needed a vaccination (required for school in new state but not in old state), and there was blood work ordered for one dd. 

[greenbeanmama]

I didn't know that doctors/clinics could do that.  I'm so glad we go to the family doctor I've seen since I was five years old.  He's made house calls when needed.  Sometimes we even discuss a sibling's medical need at someone's appointment, and he just writes a prescription or sends a referral, etc.  I have no clue what we'll do once he retires.

[OnMyOwn]

I think this is becoming the norm because many of us have to have an annual physical screening, "well visit" in order to maintain our insurance.  It's a yearly requirement.

 

I have three months a year to have a set of specific labs done, and a "well visit" with my primary care physician.  He is then required to send a third party a screening form based on my results. Then we have healthy living requirements based on our values.

I have never heard of having to have a well visit, so I hope this isn't the new trend.  It's going to make me furious if I have to go to the doctor just to keep my insurance.  

 

I had assumed that since the insurance companies often pay 100% for the well visit, they want to make sure you can't use it to address an ear infection or something.  Annoying!

[cintinative]

I have never heard of having to have a well visit, so I hope this isn't the new trend.  It's going to make me furious if I have to go to the doctor just to keep my insurance.  

 

I had assumed that since the insurance companies often pay 100% for the well visit, they want to make sure you can't use it to address an ear infection or something.  Annoying!

 

I am required to go annually and get something signed by my doctor saying I had a well check up just to maintain the rate of insurance we have through my husband's company. I am worried next they are going to ask for copies of our bloodwork, etc. The doctor has even alluded to that coming down the road the way things are going.  

[Butter]

I haven't had that experience, but I have known people who have.  It seems common.  A couple have asked and they were told (by different doctors) it is because of insurance changes due to the Affordable Care Act.

Edited January 21, 2016 by Butter

[Wheres Toto]

If it's an insurance thing, some doctors are evidently choosing to ignore it and keep coding just as a well visit.  The visit I "owed" the doctor for was February of last year.  I know all of us except maybe dh have gone to other doctors for wellness visits since then and this hasn't happened even once.  

 

What's interesting is this doctor is a private practice, just him and two nurse practitioners but both my ob/gyn and ped are part of a big corporation that's been taking over all kinds of doctor's offices around here.

[lynn]

That happens here also. Dh thought he was going for a yearly physical but one question about an ailment it's billed either a short visit under a certain amount of time or a long visit if over a certain amount of time. It stinks but seems to be the new trend.

[SparklyUnicorn]

I think this is becoming the norm because many of us have to have an annual physical screening, "well visit" in order to maintain our insurance.  It's a yearly requirement.

 

I have three months a year to have a set of specific labs done, and a "well visit" with my primary care physician.  He is then required to send a third party a screening form based on my results. Then we have healthy living requirements based on our values.

 

Really?  I have never heard of such a thing.

[SparklyUnicorn]

I think it is bull.  If anyone knows about coding they know that the actual visit is never as long as what is billed for.  They exaggerate all the time.

 

I think it is fine to bill for well and problem visit if one is actually getting that.  Mentioning something in passing with a few second comment from the doctor is not a problem visit. 

 

 

[QueenCat]

We haven't had that happen. Three of us had well checks in November. All of us have chronic issues that were discussed in those visits. They were charged to the insurance company as "well visits" so they were covered at 100%.

[melmichigan]

I have never heard of having to have a well visit, so I hope this isn't the new trend.  It's going to make me furious if I have to go to the doctor just to keep my insurance.  

 

I had assumed that since the insurance companies often pay 100% for the well visit, they want to make sure you can't use it to address an ear infection or something.  Annoying!

 

This is employer mandated.  DH works for a company with 10,000 employees.  All are required to participate in healthy living requirements, regardless of insurance carrier,  PPO and HMO. 

Really?  I have never heard of such a thing.

 

This is the third or fourth year that we have had to do the blood work and physical results.  The primary doctor has to report our weight, blood pressure, cholesterol level, blood sugar level, and tobacco use.  We also have to do an annual health survey and follow-up if our measures are out of a target range.  This is for a very good BCBS PPO plan with a deductible and co-insurance.  The HMO's have additional requirements.  Again, this is to maintain our level of insurance.  If one doesn't do it then you pay double the deductible, co-insurance, and out of pocket expenses for your entire family for the calendar year, so it's not really optional for us.

[kiwik]

If they ask if you have questions do they mean non medical ones? Here you only go to the doctor if you have an ongoing medical condition or are actually sick. Children are checked by a nurse for a few years at increasing intervals until 5 and get a free check by a dental nurse at 6 to 18 month intervals depending on need though.

 

Eta. They should have sent a bill and followed up.

Edited January 22, 2016 by kiwik

[freesia]

This happens to us at the kid's ped, but not at our family doctor. It drives me crazy. I wish I had been given a sheet that told me what I could or could not speak about at well visits. They ASK if we have any concerns, but no warning that if we answer it's a sick visit. ACK

[kiwik]

This happens to us at the kid's ped, but not at our family doctor. It drives me crazy. I wish I had been given a sheet that told me what I could or could not speak about at well visits. They ASK if we have any concerns, but no warning that if we answer it's a sick visit. ACK

Maybe the want to know if you are worried about terroists or mortgage rates?

[SparklyUnicorn]

This is employer mandated.  DH works for a company with 10,000 employees.  All are required to participate in healthy living requirements, regardless of insurance carrier,  PPO and HMO. 

 

This is the third or fourth year that we have had to do the blood work and physical results.  The primary doctor has to report our weight, blood pressure, cholesterol level, blood sugar level, and tobacco use.  We also have to do an annual health survey and follow-up if our measures are out of a target range.  This is for a very good BCBS PPO plan with a deductible and co-insurance.  The HMO's have additional requirements.  Again, this is to maintain our level of insurance.  If one doesn't do it then you pay double the deductible, co-insurance, and out of pocket expenses for your entire family for the calendar year, so it's not really optional for us.

 

We have a very good BCBS PPO.  Never had to do that.  I wouldn't care for it.

[SparklyUnicorn]

If they ask if you have questions do they mean non medical ones? Here you only go to the doctor if you have an ongoing medical condition or are actually sick. Children are checked by a nurse for a few years at increasing intervals until 5 and get a free check by a dental nurse at 6 to 18 month intervals depending on need though.

 

Eta. They should have sent a bill and followed up.

 

No they mean medical ones, but apparently they really don't want you to ask questions.

[Annie G]

This is employer mandated.  DH works for a company with 10,000 employees.  All are required to participate in healthy living requirements, regardless of insurance carrier,  PPO and HMO. 

 

This is the third or fourth year that we have had to do the blood work and physical results.  The primary doctor has to report our weight, blood pressure, cholesterol level, blood sugar level, and tobacco use.  We also have to do an annual health survey and follow-up if our measures are out of a target range.  This is for a very good BCBS PPO plan with a deductible and co-insurance.  The HMO's have additional requirements.  Again, this is to maintain our level of insurance.  If one doesn't do it then you pay double the deductible, co-insurance, and out of pocket expenses for your entire family for the calendar year, so it's not really optional for us.

 

We have to go through this for our insurance too. 

[OnMyOwn]

This is employer mandated. DH works for a company with 10,000 employees. All are required to participate in healthy living requirements, regardless of insurance carrier, PPO and HMO.

 

This is the third or fourth year that we have had to do the blood work and physical results. The primary doctor has to report our weight, blood pressure, cholesterol level, blood sugar level, and tobacco use. We also have to do an annual health survey and follow-up if our measures are out of a target range. This is for a very good BCBS PPO plan with a deductible and co-insurance. The HMO's have additional requirements. Again, this is to maintain our level of insurance. If one doesn't do it then you pay double the deductible, co-insurance, and out of pocket expenses for your entire family for the calendar year, so it's not really optional for us.

Okay, I guess I have been exposed to something like that in recent years. For us, we get a $1000 "discount" if mt husband gets a flu shot and takes a seminar. But, I can see what direction this is headed in now!

[kiana]

Holy cow, I am so lucky that my NP doesn't do this.

 

The whole *point* of a wellness visit ought to be that you can address minor concerns before they become major concerns.

[magnificent_baby]

I'm in school to be an NP and from my (limited) experience, this is mainly an insurance issue. The insurance company will review your visit notes and if they find anything that is not preventative in nature, it may not be covered. The billing lady also explained to me that a third party paid associated with the insurance company is often involved in reading the charts to catch the "extra" issues that occur at a wellness visit. Many are automatically denied no matter what. One of my preceptors will warn the patient that has an issue to be addressed, that it may not be covered at the wellness visit (or charged separately) and she suggests making an appointment for another time. The only exception to this is if we find something alarming during the exam that needs addressed immediately. She then explains that although it may not be covered, it would be imperative to look into right away. She provides very detailed documentation in the chart to explain the need to pursue it that day. IMO, the provider should warn you, but ultimately when it comes down to it, I think it's the patient's responsibility to know their insurance details. 

 

Personally, I've never had to come up with anything out of pocket but would be upset if I did. I used to have a list of questions for my pede at wellness visits since we don't go in very often, but now I'll have to rethink that. As a soon to be provider, trust me, it would be SO much easier to not worry about that aspect but it's reality. 

 

OP, I wouldn't change doctors over this right away. It happens everywhere. 

[3 ladybugs]

I have had it happen at an eye appointment. I went in thinking I had 20/20 vision and came out with an astigmatism. The appointment wasn't considered routine because I got diagnosed with something at the eye appointment. Never mind the fact that I don't need glasses for it. :rolleyes: My boys both have astigmatisms and one of them is known near sided. He will need glasses before he drives, it is just a question of how far before he drives. I guess none of us will have "routine" eye appointments anymore. 

 

I wonder if I could argue that when I see my oncologist that it is really a well visit? I mean I haven't had cancer for 5 years. I see her once a year. So isn't that a well visit?

[cjzimmer1]

 

 

This is the third or fourth year that we have had to do the blood work and physical results.  The primary doctor has to report our weight, blood pressure, cholesterol level, blood sugar level, and tobacco use.  We also have to do an annual health survey and follow-up if our measures are out of a target range.  This is for a very good BCBS PPO plan with a deductible and co-insurance.  The HMO's have additional requirements.  Again, this is to maintain our level of insurance.  If one doesn't do it then you pay double the deductible, co-insurance, and out of pocket expenses for your entire family for the calendar year, so it's not really optional for us.

 

We've had something similar to these with 3 different companies that DH has worked for although none of them require a doctor's visit.  All 3 places have a day where a groups of nurses comes in to the office and does the necessary weight and blood work checks.  Spouses can choose to come in to the office or have the screening done at local Walgreens.  But if you choose not to do the wellness screening you have to pay extra.

 

DH's last employer had the stupidest online program you could do in addition to earn extra money for your HSA.  You would have different healthy options to choose, you have to "commit" to do them for so many days and then come back and say you completed them.  Things like get 7 hours a sleep for 5 nights in a row.  Make all the grains you eat for 3 days in row whole grain instead of white.  Buy a good pair of walking shoes.  Take five minute "stress" breaks every couple of hours.  Stuff that is complete common sense and the majority of the food stuff we already did as a family.  It was a complete time waster and I learned absolutely nothing new.  DH gave me his login and so I logged in each day for both of us and clicked are appropriate boxes and quit as soon as I achieve our maxim savings each quarter.

 

[Sun]

If it's an insurance thing, some doctors are evidently choosing to ignore it and keep coding just as a well visit.  The visit I "owed" the doctor for was February of last year.  I know all of us except maybe dh have gone to other doctors for wellness visits since then and this hasn't happened even once.  

 

What's interesting is this doctor is a private practice, just him and two nurse practitioners but both my ob/gyn and ped are part of a big corporation that's been taking over all kinds of doctor's offices around here.

 

Huh. This is really interesting to me. DS and I both have had well visits in the past two months, and we brought up concerns and chronic issues at both appointments. Both were billed as well visits, even though both generated referrals for tests and appointments with other providers. We also don't have to have a well visit each year for insurance purposes. I guess I'm even more appreciative of our doctor now that I've read all these stories here!

 

[Alice]

I'm not at all a billing or insurance expert but I wonder if this has to do with the ACA. Under that insurance companies (even private ones) must cover preventative care without "cost-sharing" meaning that certain preventative services must be covered at 100% cost by the insurance company. Obviously, insurance companies do not want to pay the 100% if they can avoid it so they are looking for anyway possible to call a visit something other than preventative care. 

 

I'm a pediatrician so this doesn't effect me as much and I'm not as up to date on it. Most of the questions and things that would come up at a well child physical fall under preventative care because kids don't have as many chronic issues. If I do discuss things with parents that are outside of the WCC then I might document it in the chart but I don't bill different for it. I'm not sure if the insurance companies will have a problem with that if they audit the charts. Probably. 

 

There are other places I've noticed billing changes from ACA that effect patients in ways they may not realize. A big one is in hospitalizations. If you are going to be in the hospital for less than 24 hours then we have to put it as "observation" instead of "inpatient". The difference is often in how much insurance will pay rather than the patient. This really effects pediatric patients because it is very common that they will be admitted for a short time but still really need to be hospitalized: a baby who needs phototherapy, a baby who is really dehydrated from a stomach virus, a kid with asthma who needs intense treatment. Kids can get sick fast and need more intense care but they often get better fast too. I used to try and admit them as inpatient because I felt they met the criteria for inpatient care even if they were only there a short time but I've gotten in trouble with the hospital for that. Now the computer system is such that we really can't admit them as inpatient unless we can document why they will be there more than 24 hours. It's frustrating because I know it means the parents will be stuck with more of the bill but there also isn't much I can do without openly lying and committing fraud.