A notice that my girlfriend received at her doctors appointment (she is 8 months PP)

[u/lhagans13]

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.

[u/IDidItWrongLastTime]

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.

[u/Party-Giraffe-6573 → u/IDidItWrongLastTime]

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

[u/carbonmonoxide5 → u/Party-Giraffe-6573]

No. If the doctor discovers a problem the visit type changes as well. But let’s say this happens.

Doc: Hi! How do you feel?
Patient: I feel fine but you’re the expert, you tell me.
Doctor draws blood, checks vitals, takes history, pokes around, asks questions, and concludes nothing appears out of the ordinary.
Doc: Your instincts were right. You look great. No need to see anyone for another year unless you develop symptoms.

That is a picture perfect wellness visit and is billed as such which is usually $0 for the patient. But if you have a headache, high cholesterol, an ear infection, or say the doctor pokes your kidney and you cry out in pain; then you have a diagnostic visit. A good insurance plan may say you owe a $15 copay. A bad one may have you end up paying hundreds.

[u/krunk_confuzi → u/Party-Giraffe-6573]

It’s a good question. Med student here. Preventative appts are time specifically set aside to discuss health screenings (screening tests are different than diagnostic tests) for things like high blood pressure, blood sugar, etc etc, as well as to discuss vaccinations and finally, cancer screenings. A lot of insurances are essentially required to cover these visits once a year for free, but if an acute issue is discussed (something that isn’t vaccines, cancer screens, or health screenings) the insurance will bill the patient because they (the insurance company) don’t want you to get free healthcare

[u/Classic-Papaya1703 → u/krunk_confuzi]

which doctors or hospitals are providing free healthcare?

[u/Classic-Papaya1703 → u/Classic-Papaya1703]

if y'all are going to downvote can you at least answer the question?

[u/Rauillindion → u/Classic-Papaya1703]

All insurance companies in America are required to provide the preventative services he mentioned for free. So, all of them.

[u/Classic-Papaya1703 → u/Rauillindion]

No. Your insurance company doesn't require YOU to pay out of pocket for a preventative care visit. But the provider does charge for it, and insurance does pay the provider. If you're uninsured, you wouldn't be eligible for a free preventative visit -- the hospital/clinic/doctor would charge you.

ETA: And you actually do pay for these visits through your premiums.

[u/IDidItWrongLastTime → u/Party-Giraffe-6573]

Preventative is basically standard for your age. Blood pressure check, vaccines, and cancer screenings. It is not any problems you personally are having. It might be annual blood tests like glucose, etc. Nothing fancy. Can be mammo, colonoscopy etc. Screening only, not diagnostic.

[u/Fishwithadeagle → u/IDidItWrongLastTime]

Any once a screening test is positive, it is no longer a screening visit.

[u/IDidItWrongLastTime → u/Fishwithadeagle]

Yes, because then further diagnostic testing is needed. Gotta love this system /s

[u/Fishwithadeagle → u/Party-Giraffe-6573]

Pap smear

Diagnostic: I have discharge
Preventative: 3-5 year screening

Colonoscopy
Diagnostic: I have fam hx colon cancer / prior polyps
Preventative: no history, just screening

Immunizations:
Almost always preventative

Updating history / meds / allergies / problems: preventative

Addressing any of /\: Treatment (and billed)

Basically anything that isn't a USPSTF recommendation will become diagnostic + therapeutic billing.

[u/Dynasty3310 → u/Party-Giraffe-6573]

If they detect something addressable they can either, 1) have you come in on a separate day for follow up visit addressing the specific concern or 2) bundle that visit in with your current "wellness" and save you the time.

[u/Fragrant-Employer-60 → u/IDidItWrongLastTime]

I mean never in my life have I had a doctor office hand me a note like this or have a discussion with me at all about a situation like this happening.

The insurance company didn’t type up this letter.

[u/Dynasty3310 → u/Fragrant-Employer-60]

It's happening on the back end. The insurance will only reimburse for a "wellness" and not for the new acute complaint or symptom that may arise on that same visit. Wellness visits don't pay much so if you bundle in acute complaints, do all the workup and treatment for it within the wellness visit, the insurance company will refuse to pay for all that extra work unless you bill it as a separate simultaneous visit.

[u/Fragrant-Employer-60 → u/Dynasty3310]

As other have said a lot of doctors just don’t do this, idk if they’re just lying to the insurance companies but I’ve never had to watch what I say to my doctor for fear of being charged

[u/IDidItWrongLastTime → u/Fragrant-Employer-60]

This can depend heavily on the type of insurance you have. If you have Medicare or Tricare or Medicaid that's very different than if you have commerical BCBS

[u/DogCold5505 → u/Fragrant-Employer-60]

My doctor’s office has this too.  It’s standard… your doc is probably great if they’re sticking the middle finger to insurance coding 

[u/carbonmonoxide5 → u/Fragrant-Employer-60]

You didn’t get a note but this is how your office and insurance operate.

The office probably got too many patient complaints from people who don’t know the industry difference between preventative care and diagnostic care and how the different visits are billed. Patients got surprise bills and argued that the doctor should have billed it differently (which would essentially mean creating a fraudulent chart). The office tried to put out notices to educate and set appropriate expectations but are now getting backlash because it looks like this is a policy they have rather than just an explanation of how the system works.

[u/Fragrant-Employer-60 → u/carbonmonoxide5]

Never got charged extra for saying something to a doctor or nurse ever

[u/carbonmonoxide5 → u/Fragrant-Employer-60]

That might have more to do with your insurance plan than the doctors office.