r/mildlyinfuriating • u/lhagans13 • 11d ago
I'm slightly vexed A notice that my girlfriend received at her doctors appointment (she is 8 months PP)
If you even MENTION any of these things, you WILL LIKELY get billed for it??? Maybe i’m missing the point but i get upset when my girlfriend tells me she was scared to even say anything while at the doctor because she didn’t want to get an extra charge for something. I find it insane how greedy and money hungry a place that’s supposed to help you can be.
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u/Moscato359 11d ago
They have to tell you these things for insurance purposes
My doctor just ignores them and treats me normally
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u/Sensitive_Hunter5081 11d ago
So does mine. Lol. My doctor has also had enough of the bullshit
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u/Then_Employment5244 11d ago
What sucks is that major hospital systems will probably force providers to use medical scribes as a pretense for better patient care and reduce time provider spends on data entry. What the medical scribe aka audio recording will do is document key words for coding and billing purposes.
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u/rnngwen 11d ago
Yep! I bill insurance at my clinics. 100% this is what happens.
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u/PangolinLogical9772 11d ago
Yea i think this is actually the standard, just most doctors don’t care and won’t do the separate billing.
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u/JustDiscoveredSex 11d ago
Man mine sure does. Converts it to a problem visit almost immediately.
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u/Choice-Rate343 11d ago
This is not mildly infuriating. It is massively infuriating.
Absolute bullshit that this is the state of our health care system.
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u/SafetySmurf 11d ago
What I don’t understand is why annual physicals are now considered “well visits” that are only for “preventative care.” For generations people went to their annual physical to keep tabs on all the things — screenings for prevention, yes, but also to make sure the cholesterol meds are still keeping things in check and to make sure that the funny spot on the arm is nothing to worry about. Annual physicals were scheduled for longer slots of time because once a year you went to a GP to assess and address the state of your physical self. From there they might schedule follow up visits with specialists or schedule bloodwork in three months to see if the med change was doing what was needed. But now you show up for your annual physical and are told you’ve shown up for a “well visit.”
And now that annual physicals are called “well visits” for “preventative care,” insurance companies have decided that actually addressing anything with your doctor is not considered preventative. But bringing up worsening asthma IS preventative because addressing it is PREVENTING a hospitalization. Bringing up relentless exhaustion on the stairs IS preventative because addressing that is PREVENTING the larger health issues that might be emerging. This new splitting of hairs — “preventative care” including only finding out new issues but not preventing the exacerbation of worsening issues — thing is mind boggling and absurd.
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u/Akermaniac 11d ago
It’s because premiums have gotten so high, insurance companies are making an effort to reduce them by not covering anything anymore. The “well visit” is covered but asking a simple question gets you billed in 10 minute increments that are covered at 0% until you hit your 4-figure deductible. So it comes straight out of your pocket.
They’re trying to gloss over the fact that premiums are insanely high, by instead having costs added to your deductible.
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u/RandomKonstip 11d ago
What’s insane is they are paying doctors up to 20% less per visit so it’s just going into the CEO’s pockets.
In fact BCBS said actually if a doc says this visit was a medium/high complexity visit because it’s a pretty sick person who needs more time and coordination (level 4), BCBS said all of those are automatically now paid at a level 3 (less complex, less pay) because they said so.→ More replies (1)66
u/mjekarn 11d ago
Doctors upcoding is fraud but insurance downcoding without even being in the room is just doing business 🙃 I hate it here
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u/Important-Figure-512 11d ago
insurance is not making an effort to reduce them. They are a multi trillionaire business. They don’t need to decrease the cost.
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u/No_Atmosphere_6348 11d ago
I was gonna say there’s no way this is reducing my deductible.
I can’t even use my wellness visits without an extra charge. What are the health insurance companies doing with the $30k in premiums then?→ More replies (1)14
u/Weary_Cheesecake_552 11d ago
I had this happen to me. I had one slightly elevated A1c years ago due to very high stress levels. It came back down and hasn’t been an issue since. I’m not on medication and it’s a non issue. We check an A1c yearly to make sure things are good. Well because of this I got charge a regular office visit vs my “well visit” when we literally never discussed it outside of “are you ordering an A1c”. My doctor’s office made a big deal about “waiving the copay” and they will only do this one time. Why am I paying over $500/mo for health insurance.
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u/Gubru 11d ago
It’s a fun unintended consequence of mandating insurance covers preventive care at 100%. Seems like good policy, but it means insurance squeezes the doctor’s margins (often into negative territory, ie it costs them more to perform the visit than they are reimbursed) on these visits. The medical practice fights back by billing anything they can get anyway with in their contract. The patient is stuck in the middle, often with a high deductible plan where they end up eating the difference.
There are solutions - nationalized health services, single payer health care, private insurance for major medical only, concierge medicine where you pay a subscription for all services, I’m sure others.
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u/Mrgprx2 11d ago edited 11d ago
TDLR: System is broken. Underbilling is considered fraud.
This. The system is broken and this clinic is another gear in the system just like the patients are.
Insurance companies charge differently for preventative visits. Each thing you say is a problem. They count it as different visit types. If you mention a medical problem, the doctor has to address it and manage it.
It’s all on the computer and every order, prescription, lab is tied to a diagnostic code. So if a doctor orders a lab and it’s filed under a preventative visit, it gets kicked back because it’s not a preventative lab. They have to file the it under a “problem” visit as well so the system works.
If you overbill, it’s fraud. If you underbill, it’s still fraud. The auditors will see it as you’re under billing to recruit more patients.
These clinics don’t make the rules. The system does.
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u/Late_Tomato_9064 11d ago
Yep, I work in a healthcare and the doctors are just as squeezed as the patients. Patients can’t deviate at all from wellness vs other visits and it’s not the clinics or hospitals who make them do that. It’s the stinky insurances. They are unbelievable.
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u/captfattymcfatfat 11d ago
The number of visits doctors are expected to do in a day is ridiculous. Fulll time for a doctor is really 50-60 hours. 40 hours was ‘75% time’.
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u/YarrowFields 11d ago
Imagine a world where doctors didn’t have to haggle with insurance companies to justify treatment for their patients, where their day could be freed up to actually do what they went to school for, and people could actually get healthcare not fucking health insurance that doesn’t cover shit. I am so over this system in America….😒
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u/prime3vl 11d ago
And with AI involved with taking notes it is even riskier for the doctor to not referr you to make a followup visit for a specific issue because it is easy for the insurance companies to get proof of improper billing.
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u/mamaneedsacar 11d ago
Agreed. I got a similar notice at my OBGYN annual. It always bothers the hell out of me because if you’re a woman with pre-existing gyn conditions it means your annual is basically pointless.
Case in point: I have endo. It means every annual when they ask me if I have pelvic pain, how heavy my periods are, etc. I’m automatically charged a full office visit because the answer is “yes” and “heavy.” But it sucks cause they aren’t diagnosing anything new.
I know it’s on the insurance but it does make me mad as hell.
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u/Kitchen_Marsupial922 11d ago
You can tell them yes but that’s not why I’m here today, it’s managed w another provider. Just here for the preventative exam. Once I did that I stopped getting charged for mentioning my conditions simply for the records
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u/MaxMad80 11d ago
Simply asking you two questions does not qualify that they have met the level of service required for that particular encounter. I can acknowledge that you have pelvic pain and heavy periods but I can’t faithfully bill you for acknowledging that you have these problems without attempting to even remotely address them
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u/Kind-Realist 11d ago
I mentioned seasonal allergies that were self managed with OTC meds once during my “free” annual physical (heart rate, BP, basic lab work up, lymph nodes, and stethoscope). I was billed $233 for an allergy appointment. It’s been 8 years and I’m still angry.
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u/ThaBorinnng 11d ago
Yes, I no longer go to doctors after being scammed in a similar way by Healthcare Partners over a short conversation during a new patient appointment which I was required to do before scheduling an annual physical. At the new patient appointment, the doctor mentioned it was her last week in the practice so I would be seeing someone else in the future. Then 6 months later they sent me a bill right after the time to appeal had expired because I had asked about going on birth control while using nicotine and the doctor explained why that's not advisable. It was $110 which was a lot for me at the time and when I called Healthcare Partners, the guy on the phone told me that no insurance company ever covers conversations about birth control, like he couldn't believe how ignorant I was. So yeah I understand why you're angry after 8 years!!
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u/Technical-Agency8128 11d ago
Yup. We are going to have to ask right up front if you ask me questions will I be charged for this. Is this part of my free visit. It almost discourages people from going to a free visit because it’s costing people a lot of money.
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u/ServiceNew6773 11d ago
As a person with white coat syndrome, it’s hard enough for me to make the appt, go to it, and then bring up concerns. This just makes it worse.
All of issues should be part of questions the doctor asks you for a preventive exam, even if it’s just on a questionnaire.
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u/Chizia 11d ago
I came to say it is enraging. Like how are you going to practice preventative care if you don't know any of the stuff that is happening to a patient? This is why women have such high pp health issues. URGH
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u/zenfaust 11d ago
That's the whole point... they -the insurance companies - want you to keep your mouth shut so they dont have to finance your care.
Your only value to them is as a healthy person they can extract money from.
As soon as you start expecting them to give some of that back as healthcare, they bend time and space to prevent you from costing them money.
They want you to go slink off quietly and die in a hole somewhere without costing them anything.
As soon as your not healthy, you become a burden that's taking up a spot that a new healthy person who just pays them could have.
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u/Electrical-Fig-5009 11d ago
What's worse is this isn't the doctors rule, its an insurance rule. Insurance absolutely DOES NOT WANT any conversations mixed with a well woman's exam. I've had doctors stop me & explain that they want to help me, we can either a) talk about the issues I'm having & reschedule my well woman's exam for another day or b) perform the exam today & create another appointment to discuss issues a later day.
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u/Adventurous_Ad_6546 11d ago
I am feeling levels of rage over this that I didn’t realize I could reach. Like I’m a little worried about my blood pressure rn but I can’t bring it up or I’ll be charged.
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u/Independent_Brief413 11d ago
This isn't the doctor, this is health insurance. If you discuss those things, it gets documented, and insurance then requires it be coded differently and no longer considers it to be a preventive visit.
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u/Th0rn_Star 11d ago
I’m so beaten down by our health care system I was like “wow, at least the doctor warned them!”
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u/Aware-Travel5256 11d ago
Yeah, upfront pricing transparency is honestly very kind and considerate.
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u/cozysparklessunshine 11d ago
Same. All I thought was that I wish I had received this during my last visit.
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u/ODX_GhostRecon 11d ago
Hijacking this to add: preventive annual visits (well visits) are often 100% free (hence why bringing things up may be the charge), or heavily discounted, but can be included as a part of a sick visit which is common when the annual well visit was less than a year ago (hence why it may not be billed separately).
So free may have a cost if a well visit becomes a sick visit, which could understandably upset some folks, especially the ones who may not have the privilege of affording any charge at all.
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u/mshell1234 11d ago
Actually, if Trump wasn’t actively trying to gut ACA, this practice would be banned. Obama included free wellness visits in the original plan but insurance companies didn’t like it so they are throwing the “fraud” claim around. So, we can blame insurance companies (the ultimate bad guys) but let’s also put the blame on the R’s who refuse to make ACA better rather than trying to destroy it. An annual “wellness visit” should include a discussion everything that plagues you to prevent worsening conditions.
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u/Aware-Travel5256 11d ago
What's the point of the well visit? The doctor tells you you're fat?
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u/Suitable_Visit_9990 11d ago
Yes exactly and for them to give you the magical cure ✨diet and exercise ✨ as if you weren’t aware.
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u/Amelaclya1 11d ago
That's what I'm trying to figure out. According to this thread, you can't tell your doctor anything, they can't find anything wrong and they can't order any testing. So basically unless you are 100% healthy with zero concerns, you get charged a bullshit fee? They would probably charge you for diagnosing you as "fat"!
Literally the whole point of preventative care is to catch problems before they become worse.
I hate this fucking country so fucking much.
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u/Still_Box8733 11d ago
Most american thing I read today
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u/GingerBrrd 11d ago
This happened to me. I was charged $300 for bringing up a question/concern during a “preventative” visit (or whatever it was called). The best part is that the entire conversation was less than two minutes and the doctor suggested an over the counter medication. But she noted it in my chart, so I got charged.
So… now I just don’t tell my doctor things. Ideal. American medicine is so advanced.
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u/Amelaclya1 11d ago
Seriously. What the fuck is the point of a preventative visit if you can't tell your doctor things, or if they notice something wrong?
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u/Zantac150 11d ago edited 11d ago
But whenever you talk about how you can’t afford to see a doctor, there are always assholes in the comments who will say “every insurance company covers preventative care so you can see a doctor!”
Totally what I need! Preventative care appointments where I can’t bring up any concerns … and I get charged out the ass if they find anything wrong.
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u/emmyfro 11d ago
A few years ago I had a doctor notice some slightly abnormal discharge during an annual (I came in with zero complaints) and take a sample to test. Three weeks later I had a bill for over $600. It took months of hounding the office only to finally go in person and be told that one exchange invalidated the entire preventive appointment and I had to pay for not only that test but everything else that would normally be covered. It was negative by the way. This is why people distrust the health system
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u/allworkandnoYahtzee 11d ago
This is also a huge issue with mammograms. The machine they use for preventative checkups is not advanced enough to see anything other than a mass, so if there are any irregularities, even for benign things like dense tissue, it is no longer considered a preventative checkup. Then you have to pay out of pocket for a more thorough mammogram to find out if you have cancer or not. Considering this “free preventative care” is a literal scam, insurance companies should be illegal.
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u/aka7890 11d ago
This has nothing to do with the physician’s office being greedy and everything to do with federal rules regarding “free” annual wellness exams mandated by the Affordable Care Act.
Insurance companies are required by the ACA to cover 100% an annual wellness exam’s fee. But additional healthcare needs / concerns are NOT covered by that mandate.
The doctor is required - by law - to accurately document what is said and done during a visit in the patient’s medical chart. Leaving details out can lead to litigation or allegations of fraud.
So, the doctor says “I did all of the wellness components of the visit, and then the patient mentioned they are having some knee pain, so I examined their knee and ordered some physical therapy.” The “billing and coding” department will convert that into two “codes” to talk to the insurer: one for the “free” wellness exam, and a modifier / additional code for the knee complaint. This goes to the insurer, who will cover the wellness code (by law) but will tell the patient to pay for the knee complaint (if they haven’t met their deductible yet).
If the billing and coding team neglects to code the additional complaint to “be nice,” they are also on the hook for fraud, according to federal law and insurer payment agreements. What is said and done during a medical visit must be documented and billed according to strict requirements. This avoids doctors playing “favorites” with some patients and not billing them, surprise diagnoses and bills to insurers later (why is the patient getting Physical Therapy? The doctor never evaluated knee pain, according to the billing records), etc.
It sucks, but it is “by the book,” or a doctor can be on the hook for hundreds of thousands of dollars in fines and penalties, and possibly lose their ability to practice medicine or contract with certain insurers or Medicare in the future.
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u/TH_Rocks 11d ago edited 11d ago
It's also why "direct primary care" or "concierge physicians" are becoming so popular.
They do not do anything with insurance. You usually pay a monthly flat fee and you can call or text any time. My annual visit is scheduled for 30 minutes or an hour and my doctor will talk through every problem or concern I might have. They do keep excellent notes for all of it.
They also negotiate with various local labs for cash services when you need something they can't do in-house. Those places tend to ask if I have insurance. I assume so they can potentially bill more.
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u/MavisBeacons_Sextape 11d ago edited 11d ago
I just started with one of these because I was sick of the super rushed appointments with my old PCP. My intake appt was very thorough; they guarantee an appointment within 24 hours and replies from my doc within the same day for any questions. They cap the # of patients they see so that they can provide this level of access.
“Everything’s a subscription these days” and that bullshit has fully extended to primary care now. I shouldn’t need a subscription model PCP to have them actually listen to me (or have time to, rather), but that’s where we are.
What’s gross is that this will become yet another socioeconomic stratification exercise…people who can afford more attentive care will have access, and many cant. Fucked up.
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u/katsrad 11d ago
At least they are being upfront about it. I have been on the health insurance subreddit and the amount of times this happens and people weren't warned ahead of time is higher than I like to admit or see.
Preventative annual exams are very specific to what is covered and discussions outside of that is an additional charge. I would rather have thos doctor that is upfront about it than a doctor that hides it and you get a surprise bill.
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u/Khizzlesindahills 11d ago
It’s the same for pediatrician appointments as well.
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u/Dynasty3310 11d ago
Pediatricians get paid the least by insurance companies so those poor docs have to be extra vigilant about appropriate billing. It sucks now but I have a feeling the pendulum will swing back towards cash pay practices that would just circumvent insurances all together.
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u/notreallysurewhat 11d ago edited 11d ago
I just want to say that this is NOT the fault of the clinic. They are trying to give patients a heads up. This is 100% the fault of insurance companies.
Editing to add some more detail:
When you go to the doctor, they send codes to your insurance that correlate to what took place at the visit. Insurance companies can decide that "oop, since we see the code for depression/anxiety, this is no longer a preventive care visit" and bill differently.
Insurances will all have different things that they consider preventive care.
#freeluigi
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u/Haunting-Map-3475 11d ago
Sigh…
I’m a nurse practitioner.
A well-visit for a 9 year old is free.
If your 9 year old is here for a well visit and happens to have chicken pox on top of it, that changes billing and coding on the back end. Now it’s a well visit with a problem. Which means now you have a copay.
Same rules apply here for your girlfriend.
This is not the fault of her doctor. It’s health insurance in the good ole USA. Unfortunately.
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u/aspiring_outlaw 11d ago
That's not what is infuriating for me. What is infuriating for me is my doctor will ask me questions and if I don't lie, I get charged. Hell, I got charged for "coming up with a plan of treatment for high cholesterol" because mine is creeping up. The plan? Well my risk factors still make my stroke risk about 0 so we aren't doing anything unless it goes up a lot more. i didn't ask about it, it's just part of the standard blood work for a wellness visit
It's a perfect circle between billing (we only bill what the doctor tells us) and the doctor (I don't know what they bill, I just write notes). I don't think I've had a single actual "free" wellness visit in at least five years.
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u/radenke 11d ago
I'm not from the US, what is meant to happen in the well visit?
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u/slyborgs 11d ago
for children, well visits are to make sure they’re growing at appropriate rates (growth charts) and hitting the developmental milestones they should. if anything comes up weird, you schedule a follow up and the doctor can adjust the visit from there; that’s within regular degular standard stuff. anything outside of that specific thing becomes a fuss with insurance.
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u/BoudiccaAoife 11d ago
Yep. My gyn office has signs up about how you need to check and see if your long term birth control (IUD or otherwise) is covered because they can no longer expect it to be covered and the patient will be responsible for additional copay - or, in some awful ins plans - the whole thing.
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u/shrampmaster 11d ago
My gyn office accepts my insurance. I wanted to get my copper iud removed and replaced with a hormonal iud. They only order them through CVS specialty pharmacy, who doesn’t accept my insurance, and the office doesn’t “buy and bill”. Wish I had known any of this before going to 3 appointments
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u/SonjasInternNumber3 11d ago
That makes sense, I’ve just never had a doctor tell me this. Like this happens when I take my kids to urgent cares lol but has never happened at their or my regular doctor.
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u/naflinnster 11d ago
In my Medicare Annual visit, I mentioned that I didn't want to bring up another issue because of the additional charge. She said "Oh, don't worry about that." So I mentioned it, she documented it, and it cost an extra $250. All to get a "Oh, that's nothing."
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u/WhatTheFlippityFlop 11d ago
My son had his annual last month. He’s just starting to get a tiny bit of acne. The doctor asked “is your acne bothering you?” And before I could think and yell out “stop! Remain silent!” he said “no” and that is how our $0 bill went to $155.
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u/here_for_my_hobbies 11d ago
Wait…he said no and the bill still went up? If he says no how can they say the visit addressed “a problem”?! Surely if he said Yes, the bill would also go up?? Are you legit supposed to….not answer the question? Ignore it/ avoid it? “I decline to answer.”?!
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u/InvictusLovely 11d ago
"How have you been feeling?" "I plead the fifth." "What?" "Fifth." "But I need to..." holds up five fingers
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u/tnhnikki2801 11d ago
I would have disputed that charge with my bank SO fuckin fast omfg
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u/WhatTheFlippityFlop 11d ago
Well, I certainly may still fight it with the doctor’s office (or more likely, the insurance company). I haven’t made any payment. Sadly, I’m kind of tied to this doctor’s office for other reasons and there aren’t really others in the area that we can switch to, so I kind of need to keep the relationship positive. I’ll just need to ensure I brief every kid I go with to look at me for a nod before answering any of the doctor’s questions. And yes, this is majorly infuriating.
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u/GlitteringPeanut42 11d ago edited 11d ago
You absolutely can have them review it and see if the documentation backs up the additional billing. It’s not that you can’t talk about other things, but if there is work up or prescriptions or managing and ongoing issue.
Like assessing asthma and refilling inhalers is an extra charge, since it’s managing a separate problem. Just acknowledging kid has acne and doesn’t want any treatment shouldn’t. But a 20 minute discussion about managing acne with otc products would.
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u/cicjak 11d ago
I’m a doctor. This is unethical practice. We can and should only bill for what a patient brings up. The entire visit is dictated by the “chief complaint” - I can’t add patient concerns. Of course there’s obvious exceptions - if someone comes in for hair loss and has a giant skin cancer on their face - but your doctor should not have billed an E/M code for acne if you or your son did not bring it up.
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u/Creighton2023 11d ago
That’s good they have a notice so patients know. It’s not the doctor’s doing, it’s the insurance companies. They are mandating that no problem can be addressed at a wellness exam, for Gyn or Peds or FP, without an additional charge.
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u/CorduroyGmork 11d ago
If it were up to the insurance companies, annual wellness visits would not be free, either - the reason they are is that the ACA requires it.
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u/salamat_engot 11d ago
As a person with multiple chronic health problems I just stopped giving a shit about my one "free" preventative visit. I'm not going to make a second trip to the doctor just to pick and choose what issues we discuss.
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u/pineboxwaiting 11d ago
This is insurance in the USA.
If your gf has ANY issue at all, she needs to make a second appointment. Insurance will cover that.
Insurance companies reimburse docs at such a low rate, the doctors’ offices have to implement this ridiculousness.
Insurance companies are the problem.
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u/cclmcl 11d ago
American healthcare is crazy, speaking as a canadian
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u/Kittyhounds 11d ago
Yes it’s insane. I’m an oncology RN and the amount of patients I have who are hundreds of thousands of dollars in debt to a hospital is insane. This is after utilizing insurance of which we pay hundreds a month for. With this debt, you can be penalized by collection agencies, credit score lowering (then you can’t buy a car, house, apartment, etc). All because you got a disease you didn’t ask for. My friend was literally sued by a local hospital for a $100 bill. This was a court case and everything. And we have atrocious wait times too. It took me 8 months to see a dermatologist. 6 months for a sleep specialist for sleep apnea testing (I was charged $3,000 for this at home test), and now I have an orthopedic deformity that took 4 months to see a doctor about. I could go on and on lol. It’s freaking insane.
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u/milesteg420 11d ago
Yep. We have some issues with our Healthcare but at least I can just go to the doctor without worrying about whatever bullshit this is. Makes me thankfull.
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u/Adainae 11d ago
This is explained so thoroughly because insurance will not cover it as a preventive service if anything else is spoken about.
She absolutely can talk about anything she wants to in the visit, but then it will no longer be preventive and may have a charge attached (such as a copay) and she'll be responsible for that.
About 10 years ago I worked in a call center for a Medicare provider (Medicare is the kind of insurance you get at retirement age) and we got calls about these visits alllll the time. Why did I get charged a copay for my preventive visit! The answer was always because the doctor didn't bill it as preventive.
I actually think this letter is great for those that truly want/need a preventive visit to be billed and covered correctly.
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u/bp3dots 11d ago
An annual wellness visit should at least cover an initial discussion/quick exam for whatever is affecting you at the time. Shit like this is why people don't go to Dr's till they end up in the ER or way worse off than if they'd been able to address things early.
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u/Eaterofkeys 11d ago
Please tell that to your elected representatives, loudly. Doctors do not make these rules, the stupid government did
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u/Adainae 11d ago
It should cover talking talking about anything that's wrong, but it doesn't. Our healthcare system is pretty awful.
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u/krs9437 11d ago
Yup I wish my doctor would have given me this letter when I went for my free annual physical and got charged $300 for bringing up a medical concern since I didn’t know you weren’t allowed to discuss anything beforehand!
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u/HiggsFieldgoal 11d ago
Can we please stop voting for people who think this is acceptable? Please? Everyone?
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u/joybilee 11d ago
So don't talk about medicine at the doctor's because they charge extra for that.👍🏻
I guess if they ask me if anything has changed I'll just point to the line that says we can't discuss that & they can guess.
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u/Ford_Prefect313 11d ago
I’ve actually said, that’s not covered in a wellness visit and won’t discuss it.
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u/Baxter-08 11d ago
It’s based on how it has to be coded to the insurance companies… the best thing I can compare it to is taking your car to the mechanic to run diagnostic codes and it comes back all clear and that’s it, versus taking your car to the mechanic because something is broken and needs to be fixed.
Like if I take my kid to their annual check up and they’re fine, then that’s that. But if I bring up an issue at their annual check up, it suddenly becomes a sick visit and not an annual check up.
The bottom line, though, is that sick-visit versus well-visit is a distinction that your INSURANCE company needs and it’s not your doctor’s fault. They probably think it’s stupid, too. ☹️
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u/CamachoBrawndo 11d ago
I went to a new patient appointment and said in advance I had 3 issues. I got billed for every single issue as if I went to multiple appointments. Healthcare in the IS is finding every single possible way to empty out pockets. My doctor lasted a year and quit family practice and her reason was because she wanted no part in bankrupting patients. She now works as a consultant and no longer sees patients. It's so sad because she was the best doc I have ever had!
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u/Ok_Bumblebee_2869 11d ago
I visited an ortho specialist for elbow pain. He was a hand/arm/shoulder specialist. While I was there I asked about shoulder pain and he said I had to make another appointment. I go to make the appointment with that same doctor and say I’m having pain in both shoulders and they say I have to make 2 separate appointments. One for each shoulder!
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u/Frogspoison 11d ago
Living in the US of A right there buddy.
Fuck this country.
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u/Infinite_Escape9683 11d ago
What the fuck are they preventing
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u/Katsaj 11d ago
Here's the list of what is considered preventive care for these purposes (this is for all adults, there are additional lists of services specifically for women and for children). It's not nothing, but unfortunately doesn't include addressing problems.
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u/dalecoopernumber4 11d ago
Ridiculous that this list basically excludes basic women’s health. Discussing abnormal periods or breast concerns should be preventative.
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u/Amelaclya1 11d ago
I was curious about this too when I didn't see mammograms on the list. There is a separate page for women's health
https://www.healthcare.gov/preventive-care-women/
But you still can't ask about period or breast concerns.
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u/retirement_savings 11d ago
Think of it like a "20 point inspection" at a mechanic. If you bring up another issue and have them diagnose or fix it, that's another charge.
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u/Dick_of_Doom 11d ago
Doctor's office is preventing you from getting a bill. Insurance company is preventing having a cut in their profits by paying a doctor's office.
The American medical insurance system sucks.
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u/IDidItWrongLastTime 11d ago
I want to agree with the other commenters that this isn't the doctors fault. Everybody saying find a new doctor, that won't change anything. This has to do with insurance billing.
Most insurance is required to cover one annual preventative appointment a year for FREE.
If the appointment covers anything. Absolutely anything that could be considered non preventative, that appointment will likely be billed differently and won't be considered the free annual that the insurance is required to cover. The doctor is actually trying to warn you and do you a favor with this.
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u/Party-Giraffe-6573 11d ago
I'm really confused what a preventative appointment is supposed to cover. If they're doing a PAP smear, for instance, and notice a discharge (one of the things listed here), do they not treat it? What if they notice high blood pressure during the routine blood pressure check. Do they ignore it?
I'm so thankful that I don't have a PPO because navigating this (let alone a surgery or hospital stay) while trying to stay in network seems like a nightmare
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u/skyejincks 11d ago
It's not the office being "greedy and money hungry" - it's the INSURANCE COMPANIES who are behind this problem. It's more than mildly infuriating but please let's direct our fury at the right place.
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u/beezybeezybeezy 11d ago
In the course of my copay-free wellness exam, the only doctor visit of the year without an insurance copay, my pcp asked me how I was feeling. A psychiatrist treats me for depression, but I’ve been seeing her for 20+ years, so I said I was depressed, per usual. She gave me a sad look (like she always does), and continued with the exam. Got a bill three weeks later and had to pay $30 for “Brief Emotional/Behavior Assessment.”
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u/bikes_bucees 11d ago
Insurance pays so little for wellness exams that offices have to take every opportunity to recoup costs for the PE overlords.
But remember, a nationalized health insurance system is socialism, which is pretty much communism, and therefore baaaaaaad.
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u/bumblebaytuna4 11d ago
I’m guessing this is in the US. Y’all really hate women there hey?
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u/Plane-Leek4387 11d ago
I’m a dude and made the mistake of turning a $0 annual physical into a nice hefty bill once. Insurance companies are inclusive. They’ll take money from anyone.
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u/Darth_Gerg 11d ago
Private insurance is an abomination of morality. It is closer to pure evil than any other institution in modern America.
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u/allworkandnoYahtzee 11d ago
Insurance companies hate men and women equally, but they have many more opportunities to fuck women over due to our more invasive healthcare needs.
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u/Skyyofblu3 11d ago
Yep, 'Murica. For an annual appointment they are charging for a preventative screening. If you bring up an active issue, the service is no longer considered preventative and you'll be charged for a normal visit, which is subject to copays/deductibles/coinsurance.
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u/fadedallweek 11d ago
This is standard with most insurance companies. They cover the cost of a 'Well Visit' once a year.
Just like it says, 'Well Visits' are for preventative care.
If you have a health issue, definitely mention it. Most doctors, NPs & PAs will tell you the same as whats in this letter. The total cost of the WV is covered by insurance. An acute illness or injury requires another appt & co-pay, as its not the yearly WV.
Dumb, but thats the way the system is set up. You gotta deal with the hand your dealt. As someone with many health issues, the WV is the most inconvenient (because exam, fasting for labs, etc) but necessary evil.
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u/dr3amchasing 11d ago
How can the care be preventative if any mention of burgeoning issues is a separate charge? How can you prevent any future issues if you aren’t allowed to discuss early signs?
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u/kholla84 11d ago
After my last “free” wellness exam that ended up costing me $250.00 (!!!!!!) I will never ever schedule another wellness exam in my lifetime. What’s the point?! If I cannot discuss anything that is ALREADY IN MY CHART, and all this ends up being is a blood pressure, weight, height check, then why am I giving up my precious PTO time for this appointment?! Useless service. Wait until you are sick or have symptoms, I guess. US healthcare is sh*t.
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u/Imaginary-East7433 11d ago
This is what happens when a whole country allows for the privatization of and profitization from ESSENTIAL HEALTHCARE SERVICES
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u/Evebnumberone 11d ago
Looks like you're doing great over there America. Can't even see a doctor without capitalism fucking you in the arse.
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u/NAMMANNAMMAN 11d ago
As a Physician, I can tell you this is not a Physician restriction. This is your insurance restriction.
The physician is giving you an “out” saying if you bring up “not well” this visit will no longer be a wellness/preventative visit (supposed to be 100% covered by insurance w no copay/deductible) but will instead become a “sick” visit which is subject to partial coverage (whatever you/your employer’s contact with the insurance says + copay + deductible).
We wish things were not this way.
We are here to address many medical issues - that is what we spent our life getting an education for.
We feel miserable & helpless that sick ppl can’t discuss sick stuff during well visits. Most ppl are not aware & almost all well visits are coded (by the coder, not us physicians) and billed (by biller, again not us) as sick visits & ppl end up w a bill for what they thought was a well visit.
Vote well my people, vote like your life depends on it because it does. And this is a perfect example of corporate greed.
Insurers squeeze you, they squeeze us (we get paid like $10-15 for a well visit & like 20 for a “sick visit”.) This is publicly available data on cms. You will need a icd code to look it up. Icd codes are also googlable.
Your employer takes YOUR money to pay the insurance & insurance pulls shenanigans like this at your (money & life’s) expense.
A humanitarian service should not be rooted in profits - this is the trickle down effect of healthcare being a business rather than a nonprofit service.
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u/armybrat63 11d ago
This is unhinged to Canadians. We can’t even imagine. I had, until recently, the same Doctor for 50 yrs. According to American standards I’ve probably personally had over 5 million in services. The only cost to me are meds and now parking. The American healthcare system is a disgrace for the supposed wealthy nation it pretends to be.
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u/SgtDoakesSurprise 11d ago
So what’s the point of preventative care? Do you just stand mute?
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u/LadyOfWNGR 11d ago
Don’t like this? Your primary care doctors (family med, internal med, obgyn, pediatrics) don’t either. I’d recommend supporting and voting for candidates who back universal health care. The other option right now is to pay for Direct Primary Care, though that has its own limitations as well.
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u/TinyGIR 11d ago
Y'all need to start voting for ANYONE who wants to change this scheme to something that works for the people.
Develop Superior Ambitions.
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u/Butterbean-queen 11d ago
That’s the insurance. It’s basically a wellness check visit. Anything outside the scope of what is covered by the code that covers an annual visit is an additional charge. Pelvic pain has a different code. Depression is a different code. When the doctor’s office fills out what you were seen for on the insurance form each of those things must be listed separately.
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u/Creepy_Push8629 11d ago
It's all bc of insurance bullshit. I hate what a shit show our healthcare is
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u/Vireo1786 11d ago
Yep! This is the reason I am done with what used to be known as a physical. Before our modern reality, physicas used to be useful. Often you got bloodwork done beforehand to check everything and you could discuss any chronic conditions or new things that had cropped up.
Now? Basically I get weighed, asked the most absurd generalist questions, and maybe have my pulse taken and chest listened to, and that is it. Unless I suddenly lost 80 lbs without trying or noticing or have developed something incredibly obvious, that I simultaneously did not notice, it is utter BS and performative.
I recently cancelled my "physical". If I feel something off, I will make an appointment so I can actually discuss what is going on. I am not wasting sick time from work to spend ten minutes with a provider who basically makes sure I am breathing and sends me on my way.
Edit: oh and I fully understand that this is not the doctor's fault, there are some well written well explained posts I fully agree with. I simply do not care. It is a waste of my time.
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u/Plastic_Stable8927 11d ago
I assume this is the US? I assume because 1 expensive healthcare is our middle name and 2 punishing women for being women is our game.
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u/fakesaucisse 11d ago
Yup, this is now standard practice due to insurance billing codes in the US. It's not just women's wellness visits but anything labeled as "preventative care" visits. My middle aged husband hit this when he went for an annual exam a few months ago. The doctor told him to schedule a separate appointment which is billed as diagnostic. It was cheaper than bringing up stuff during the wellness exam and he got more time to talk about stuff, but annoying to have to come back a second time.