<p>I don’t know if other cities use Yelp much, but I leave feedbacks on it a lot. My kid’s dentist called me back when I told them I was not happy with how much they charged D1 for a simple cleaning/check up. I think the dentist was concerned about a negative review.</p>
<p>SOP here in the peoples republic of CA. long before ACA. </p>
<p>Hmmm. When I was getting physical therapy, they would only schedule appts for either my neck/shoulders or my hip on a given day – they said the insurance would not allow them to bill two appointments in one day.</p>
<p>Have never had a GYN bill twice for one visit (well woman plus problem). </p>
<p>As far as mammograms or colonoscopies are concerned, only screening exams were ever covered at 100% (at least that’s how my insurance has covered them for years and years - well prior to the ACA). If anything was found during the screening, any further exams were considered diagnostic and deductibles/copays applied. I know more than one woman who got dinged with the follow-up mammogram as diagnostic and had to come up with the $ to pay for it.</p>
<p>I just looked at my dr’s website. They say that wellness exams are coded as preventive care. If anything is found that requires further diagnosis and/or other treatment, it is coded as a problem-oriented exam and billed accordingly. It says they can keep the two exams separate. I can’t tell from that if they would bill out for 2 exams on the same day. </p>
<p>I guess I can see the dr charging for two separate exams as reimbursement rates are different. If I went in today for my physical and tomorrow went in for a sinus infection, the physical would be covered with no copay, but the sinus appt would have a copay (my plan doesn’t have deductibles). </p>
<p>There’s no way I would ever want to work in billing in a doctor’s office. </p>
<p>This is how it is done under Medicare. As Medicare goes, so goes the rest of the system. It is not new under the ACA. It is like going to the dentist and getting teeth cleaned, but adding a filling while you were there. You would expect to be charged for the filling. Even though it seems like it takes “a few seconds” to write a prescription, it takes thought, clinical knowledge, and planning of care before every prescription is written. It is more difficult for patients who often get “free wellness exams” and want “everything done” for “free” as they have a high deductible, but reimbursement for the amount of work done in such a case is small for the amount of work. . </p>
<p>Personally, I don’t charge and extra office visit for the UTI or sinusitis. But I do for the diabetes follow up or the abdominal pain work up. Of course, patients want to add the “as long as I’m here problem” without being charged. </p>
<p>Every time I read one of these discussions that are healthcare related, it baffles me why so many Americans are against a true universal healthcare system.</p>
<p>alwaysamom, I am with you. Anyway, I am very familiar with billing and coding, and I have a few comments. Primary care doctors, which includes gynecology, can bill for well exam and problem exam on same day. It should be “reimbursable” by insurance with a -25 modifier on the problem exam code. Whether that goes to a deductible or includes an extra copay is another story, since each insurance plan has its own provisions. Codes themselves should be standard across all insurance plans, as they should be using CPT codes for reimbursement. The doctor is responsible for the coding, not the office staff. Even if the task is delegated, ahem, legally, the doctor “signs” the claims, (electronic signature for electronic claims), and the statement that it is not up to her is wrong, even if it is actually done that way (by delegation). This coding issue is not particularly affected by the ACA, at least at this time.</p>
<p>Not everyone’s insurance policy is an ACA policy at this time, since renewal dates will occur in all of 2014 for old policies and perhaps there will be “grandfathered” policies in existence as well. This means some people will not necessarily have the “free” well exam in 2014.</p>
<p>I am not sure that my doctor would do this or not. I will say that my kid went to her health service in college for a physical exam, which is covered by her insurance. She had another issue that was not urgent that she asked about, and they made her make another appointment for that and come another day - two visits. Your doctor could have done that as well. D would have preferred to have everything done in one visit, but I can understand why they did what they did. If her other problem was not serious, but required a lot of face to face counseling or questions etc. it would have taken more time, and was not really what was scheduled when she made an appointment for a physical. It certainly was within their right to do this. I don’t think her PCP at home would have done this, but I am not sure. </p>
<p>I would also like to add the additional documentation that an extra problem, even a “simple” one requires. I’m with alwaysmom. If we had universal health care, this discussion would be moot. It would be useful for Americans to look at the actual recommended preventative care exams and procedures <a href=“http://www.uspreventiveservicestaskforce.org/recommendations.htm”>http://www.uspreventiveservicestaskforce.org/recommendations.htm</a> and you will find that you don’t really need to see your gyn every year unless your gyn is your primary provider. The USPTF (is not a government body) and looks at evidence based research to make recommendations. ACOG (American College of OB-GYN) do have conflicting guidelines on the need for pelvic exams, but pap smears done every 2-5 years depending on age and risk is a universal recommendation. </p>
<p>Maybe we’re against universal healthcare because the government can’t even figure out how to build a website, balance the budget, or keep medicare solvent.</p>
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<p>Amen! </p>
<p>KKmama, is it possible to have your mammograms done at another facility. It alarms me as well that the reports were not sent to whom you listed as ordering physician. </p>
<p>eyemamom - Medicare runs at a lower overhead than any other insurance company. </p>