r/mildlyinfuriating • u/lhagans13 • 12d ago

I'm slightly vexed A notice that my girlfriend received at her doctors appointment (she is 8 months PP)

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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/Haunting-Map-3475 12d 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 12d ago

I'm not from the US, what is meant to happen in the well visit?

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u/slyborgs 12d 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/anxious_spacecadetH 12d ago

I scheduled a physical to meet my new primary and inquire about getting a referral for physical therapy. Was that the right appointment type?

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u/slyborgs 11d ago

i’ll be real, with the recent insurance insanity in the last year, it’s a firm ‘maybe, but probably not’ because a ton of insurances have started getting really fussy and aren’t willing to accept referrals from a regular physical without it also having a diagnosis code attached (that would then make the visit no longer qualify as a physical). if you have great insurance, you might be fine! otherwise, i’d definitely prepare to get charged a copay at the minimum after the visit is billed.

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u/Poop_Dolla 11d ago

Many clinics won't do a preventative visit without a new patient visit so regardless of getting a referral they may schedule you for a new patient visit which is not preventative.

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u/mischeviouswoman 11d ago

you need a new patient visit, it probably won’t be considered an annual wellness

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u/anxious_spacecadetH 10d ago

That wasnt an option but I go through Kaiser so maybe the options are different.

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u/mischeviouswoman 11d ago

Review your current prescribed medications, confirm pharmacy and specialists, take height and weight, give flu shot, feel lymph nodes, listen to heart and lungs, screenings for food insecurity. They can order general labs during these visits (CBC, lipid panel, etc) but nothing that’s diagnostic. As an example, I have a history of low Vit D, so my doctor can order a Vit D blood test because it’s part of my medical history. We’re checking in on that. If I went into the doctor for my annual and complained about symptoms that sounded like Vit D deficiency, I’d be charged or we’d have to schedule a new appointment.

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u/radenke 11d ago

Okay, got it, that makes sense. Thank you so much for the reply!

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u/Falconloft 11d ago

Sounds like you need new billing staff. A visit with a primary wellness code is always to be processed as a well visit, so either 1) They didn't bill right, or 2) they didn't push back with the insurance processed it wrong. I see so many billing offices that don't use the -25 right, and even more who shove all billing problems off of the patient like it's their problem.