<p>I went in for my “free” preventive/wellness check-up today. My insurance hasn’t charged a copay for this type of visit in years, so I was surprised to be handed a form to sign. I had to agree not to discuss any health issues, ongoing or new, during the visit or I would be liable for my usual $75 copay. So I had a visit during which we were not allowed to discuss adjusting medications, how I was doing with my current medications, or whether that inflamed looking ear warranted a prescription for antibiotics (then why look in there?). It was very bizarre. I’ve been seeing this doctor for 20 years and the yearly has always been the time to catch up on minor issues and tweak meds. I had two choices - pay the $75 and make my preventive visit into a health issue visit (negating that benefit) or come back for another visit. Anybody else experiencing this? And yes, I know the ACA is to blame, but is anyone else getting the feeling that insurance companies and doctors are exploiting the act’s weaknesses?</p>
<p>I’ve only had one “wellness” visit from a doc I had never seen before many years ago. He saw me for maybe 5-10 minutes and proclaimed me very fit and gave some generic advice about exercising, eating well, etc. and that was the end of the visit. I prefer to have my regular physical and checkups with my regular internist and have refused wellness visits ever since. My copay for the regular physical and checkups is $15, which I consider very reasonable. There are no restrictions on what we talk about and I get bloodwork before hand and results of that are discussed at the visits, as well as meds I’m taking and any adjustments and other medical questions or issues I may have. Have been seeing this internist for nearly 40 years, I believe.</p>
<p>Personally, I was totally UNDERWELMED by the wellness visit. I felt it was a waste of time for me and no one in our family has had one since my very cursory exam. We all feel it makes more sense to have a real doc visit, where the doc knows us and can go over any medical issues and questions we have.</p>
<p>It’s not the ACA - it is the insurance companies. Your clinic cannot legally bill for the yearly no copay check-up if there is any acute or ongoing medical care, and the reimbursements are comparatively very low for that wellness “only” check-up. People remember the days when you could show up with a laundry list and pay one price. Insurance companies, with the cooperation of large healthcare organizations, have used their diagnostic codes and deliberately obscure billing guidelines to change the doctor-patient dynamic. Insurance companies love it because the patient gets health care and the clinic can’t charge for it.</p>
<p>Independent practices have been fighting this for a while since it annoys the patients so much.</p>
<p>ETA: My wellness appointment with the NP I see are 40 minutes and cover head to toe. Very thorough.</p>
<p>My doctor bills insurance for both the preventive checkup, which insurance pays for fully, and a followup visit to discuss my meds and other health concerns, which insurance imposes the copay. She informed patients a few years ago that this was how she would handle appointments during which more than just a routine physical was taking place.</p>
<p>I’d just as soon the docs be able to bill and get reimbursed for the services they provide. I’m fine with paying a copay and want the time we spend together to be used productively rather than spouting public health messages we already know by heart.</p>
<p>I’m fine with my docs getting as much reimbursement as they can. A good coder can do a lot more for getting the MD reimbursed for the same services than one that uses a code that won’t get as much for the doc. It’s a big challenge for docs, which is why more are becoming concierge docs, who get an annual fee from patients and some opt out of dealing with insurance altogether. Sadly, insurance is greatly changing the way docs and healthcare providers provide care. :(</p>
<p>I just had my annual physical a couple of weeks ago, no copay. In addition to thoroughly reviewing with me all of my bloodwork and scans, my doc discussed my list of 4 new items. I didn’t even think to ask her if I should make a separate appointment which would be a co-pay, and she didn’t give the impression of trying to wave me off. She spent about 20 minutes with me.</p>
<p>My copay is $15 for any visit–new doc, specialist, extended visit, short visit. The insurer pays more for different types of visits and can code that the visit was more extensive and prolonged/extended. Most of my visits exceed 20 minutes. When I got to my specialist in Denver, he generally spends about an hour with me. </p>
<p>I’ve seen charges for overhead of the facility in Denver that insurer has no qualms paying. I’ve also seen billing for specialist, for extended visits, for each of the tests performed, etc. All are covered by insurer without any fuss.</p>
<p>A good medical coder is extremely valuable and can ease the provision of medical care and reimbursement, but it takes time and good coders are expensive to hire, train, and retain.</p>
<p>I had my physical as well, and so did both of my kids. We all received updated prescriptions, as well as a short discussion of our blood work results. I had my flu shot as well. No copay at all. </p>
<p>Separate but related question. While at my annual exam, I made an appointment for the flu shot clinic they run on Saturdays this time of year, and I had the shot last Saturday. This is the first time I’ve had the shot at the doctor’s office; in the past, I’ve gone to CVS and RiteAid. </p>
<p>My question is about co-pays. This time, there was no co-pay at the doctor’s office. In the past, I’ve paid $25-30 at CVS/RiteAid, even though they’re run it through my insurance. So what’s the reason I had no co-pay this year? Was it because I had the shot at the doctor’s office? Or because it was considered part of my annual exam, even though it wasn’t on the same day? Or was it because flu shots are now considered preventive care, meaning presumably CVS also would have not charged a co-pay?</p>
<p>I have never had a co-pay for any flu shot–whether at doc’s office or at a pharmacy in the community. Perhaps the terms of your insurance changed so that flu shots are no covered without co-pays? The terms of my insurance change annually–much of it remains the same but some of the benefits and co-pays DO change over time.</p>
<p>Flu shots are free as preventative care. I had mine at my drugstore, for free.</p>
<p>There seems to be a wide interpretation of the well physical. I think if it hadn’t been a surprise to me it might have helped. I would never have dreamed that I couldn’t address a possible ear infection during that type of visit. If my blood work shows that my thyroid medication needs to be tweaked, I guess I’ll have to make another appointment, whereas that has always been part of the check up. I always thought the yearly checkup was a time to build a relationship and address overall health issues. With the way my doctor is now practicing you only speak frankly with a doctor when you are in crisis. Interesting to hear how other people’s doctors are addressing this issue.</p>
<p>Doctor’s reasoning was that if they had to chart an issue, it would no longer be coded as a well visit and they have to chart every issue in case something goes wrong. So if you go in for a well visit and something is discovered, you are kicked out of the “well” category and into a copay. Not such an issue for those with low copays. Something to consider if you are insurance shopping.</p>
<p>never mind…</p>
<p>Well now that mammograms are free it has been a nightmare. Before, when I had a copay and there was a need to go back for a second mammogram, everything was covered. Now ONLY the first mammogram is free. I recently had second one because they saw something. Well I was billed for the second one, and it was a cyst that I had aspirated. I now have a 1500 bill, for a procedure that took all of 10 minutes. We have a high deductible plan, so basically its like not having insurance. </p>
<p>I even tried to shop around for my cyst aspiration, and it was a nightmare. You had to know the codes, etc. I talked to 3 different folks who gave me three different answers. Even if another facility wouldve been cheaper, they wouldve wanted their own mammograms so I wouldnt have come out ahead. Its really infuriating.</p>
<p>That sounds most unfair, partyof5. It is very challenging to try to “comparison shop” for medical care. So far, I have not had any success. I mainly try to be sure I am comfortable with the doc who will be in charge of whatever will be done with me (like surgeon, anesthesiologist, etc., IF I even get to meet them). It is a crazy system.</p>
<p>Additionally, my insurer has had me and my allergist get a letter from my Denver doc authorizing my HI doc to treat me, even tho my main providers are in HI and Denver docs are only consultants (as I live in HI). The HI doc that they required authorization to treat created the allergy program at our med school and has been practicing in HI for decades. I was extremely insulted that they required this and it was an imposition to my Denver allergist AND my HI allergist. It’s all roadblocks thrown up so that insurer can deny coverage.</p>
<p>To me, it is awful that other than your 1st mammogram was NOT covered and having your cyst aspirated was NOT covered. I guess it’s partly having a high deductible plan that makes this all the more painful and expensive. It’s wrong that so many costs are being shifted to patients, and I suspect many patients will simply NOT have further treatment, creating more crises down the road because they don’t have the money for the high deductibles.</p>
<p>My well care check-ups have been no co-pay for years and I had my well check-up at the end of August and it was no different than every other yearly check-up I have had. We discussed all of my ongoing medical issues and changed one of my prescriptions. I also got my flu shot - which has also been free for years. </p>
<p>I also had an EKG - which does have a co-pay (always has) and my doctor reviewed with me results of my blood tests. Blood tests also always have had a separate co-pay. So, in total, it cost me $40. </p>
<p>Himom you are correct, even at ourincome level I have to think about the cost of dr visits. . My husband only has two options a 3k and 5k deductible. I wouldn’t necessarily mind a high deductible plan if we didn’t also have to pay monthly premiums. We pay 300/month. I really don’t know how the lower paid employees manage at his company. We do have an HSA account but I don’t use it, because we will need it for premiums when he retires. So from them finding a cyst and aspirating it, I have a 1500 hosp bill, and a 200 radiologist bill. I just paid off my surgery bill from last summer. I was left with a 3k from a hysterectomy. It is really awful. Oh how I wish we still had the PPO with copays for everything and then I never saw a bill. Now we get all see residual lab bills as well. </p>
<p>If you have the HSA, why not use the HSA? What’s the point of saving it for retirement if you need it now? </p>
<p>You usually can’t use an HSA for premiums. Better check.</p>
<p>The HSA money will belong to,this person, like a savings, when they leave their job. Then they can use the money for future premiums when they are no longer on that plan. They cannot use the HSA money to pay for,the premiums for their CURRENT HSA plan.</p>
<p>However…it’s being penny wise and point foolish to pay out of picket for,these procedures…I mean really…it’s the same money. The only difference is once you use your deductible usually all out of your HSA, your plan will cover it all. I can’t imagine NOT using my HSA money for current medical expenses. You can bank the other money for future premiums!</p>