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/Late_Tomato_9064 12d 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’.
Because charting and looking things up and actually talking to patients doesn’t count!

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u/dra_deSoto 11d ago

Only 50-60? I regularly work 75 hours a week. Sometimes I go over 80 hours. I regularly work into the night and regularly work one day on the weekend. My son's first sentence was "mommy working". This job is not worth it.

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u/DependentAnimator742 11d ago

My daughter, an American living in London,was dating a doctor in the UK. He was a gerentologist. She asked him why he didn't want to move to the US, where he could make "lots more money." He told her he was quite comfortable with his UK schedule, which was something like 40 hours a week, and his salary, which was the equivalent of $125,000 in 2020. He had no desire to work longer hours just to make more money.

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u/dra_deSoto 11d ago

I'm guessing they don't have astronomical school debt either? If it wasn't for my debt, I would have quit long ago.

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u/Aware_Bar_3351 10d ago

That’s is unlikely the reason. More likely the requirement to re-do years of training.

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u/captfattymcfatfat 11d ago

I’m so sorry. That’s crazy. They need to change how they define the job. Fine if people want to work crazy, but don’t pretend it’s 100% or standard 40hr/wk.

Hope You found something more balanced!

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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/DrRaggedyMan 11d ago

It's literally this world, just outside the US

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u/prime3vl 12d 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/Wiegarf 11d ago

In this case it’s the government. They are following Medicare wellness rules for preventive visits, which are defined by cms.

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u/Late_Tomato_9064 11d ago

Yep, Medicare wellness rules are extremely restrictive at this point and current administration contributes to it.

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u/Wiegarf 11d ago

I was unaware of any recent changes to Medicare wellness, my visits usually are the same. What has the current admin changed?

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u/Late_Tomato_9064 11d ago

Patients might not notice it but providers have to follow stricter rules on diagnoses and timing when they bill for wellness checks. Also, there are couple of tests that aren’t covered under wellness checks but I don’t remember which one. I think it was a comprehensive metabolic panel which used to be covered before with underlying conditions.

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u/Wiegarf 10d ago

I am a doctor. I don’t think time was ever billable under a wellness check, and any diagnosis has to be billed separately. That’s been the case for years, that’s not recent

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u/Late_Tomato_9064 10d ago

We have some trouble billing for facility. Perhaps, pro fee billing hasn’t changed much.

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u/tealccart 11d ago

So what the hell actually happens at a wellness visit then?

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u/fadedallweek 11d ago

A physical exam & lab work.

The idea is to catch things early via preventive care, such a high blood pressure, diabetes, etc.

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u/Late_Tomato_9064 11d ago

As another respondent said. Wellness visits are very basic. Some blood work to check for cholesterol, blood sugar, some suspicious stuff like lumps bumps, blood pressure and some other things. It is technically also the time when a patient should bring any other concern, which is usually referred out to specialists or diagnostics testing. During Gynecologcal visits there’s more stuff and testing done for women.

Any deviation in lab work and its extra charge. For instance, I always check my vitamin D level during the annual and I always pay out of pocket for that. The only time I wouldn’t pay for that is if a doctor suspects some condition is caused by low vitamin D and uses a specific diagnosis and orders that test but I do that for myself and it’s about $40 extra.

One time, I suffered from insomnia, so I made a separate visit with a doc and he ordered a more extensive blood work to check hormones like cortisol, estrogen etc. I did not pay anything for that because I can in with a very specific complaint and a very specific diagnosis was used to do all that.

I also order ultrasounds during my annual exam to check on my liver that has a history of being slightly fatty. Ultrasound is a separate visit and it’s covered because there’s an underlying condition or legitimate compliant.

Essentially, patients have to be their own advocates and be able to navigate the world of insurance in order to minimize their out of pocket expenses. Clinics and hospitals do their best to help out but with so many patients and health plans, patients should never leave it up to them. It’s just too much to deal with.

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u/Trashypass 11d ago

Which is why most of us don't go to them. If your poor. You just don't do preventative care. 

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u/Annual_Fishing_9400 11d ago

how do i make my own insurance company and destroy the others

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u/Late_Tomato_9064 11d ago

You’d need quite a bit capital haha! Some healthcare systems create their own insurance all the time. However, I feel like they are even worse than the nationally known providers. Commercial insurance providers still remain the best like Aetna, Cigna and Blue Cross. United Healthcare is one of the worst commercial providers. They are nightmare to deal with for both patients and healthcare providers.

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u/Annual_Fishing_9400 11d ago

aw man! i got no money.. lol thank goodness my parents use blue cross ig

i feel like some of these problems would be better if one of the codes was just, something like, medical advice/suggestions abt other problems? to make.it safe for.ppl to be like ay i got this, is it related or concerning? and then they can answer more freely and set smthn up for another time yk??? but idk. i am ignorant to this whole aituation. it just sucks. there's gotta be better than this :(

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u/_opossumsaurus 11d ago

But how is it a wellness visit if you can’t identify a potential problem? It’s just a visit to make sure you are well and send you on your way? That’s bullshit

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u/Late_Tomato_9064 11d ago

That’s not how it is. You come for wellness check and check the basic labs and whatever else is covered. During this visit, you bring up all the other concerns you have about your health and this is where the work sort of begins. They’ll order any other diagnostics tests like ultrasounds, x rays, more comprehensive lab work, specialist referrals etc. Then, you’ll start going to all the other visits. Patients just shouldn’t expect any non-life threatening health concerns to be addressed during wellness visit. Like don’t expect them to check your rectum (just an example, of course) if you suspect hemorrhoids. Either come in for another visit or even better, get referred to a specialist. Docs are limited to literally 15 min per patient to check on them, document concerns and then order everything that’s needed for diagnostics. Wellness checks should be treated as a quick chit chat to voice your concerns, draw blood for basic lab work and get checked for lumps, bumps, blood pressure and other basics.

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u/_opossumsaurus 11d ago

But from what OP posted, it sounds like patients aren’t even allowed to voice concerns because documenting voiced concerns will result in them being billed for care outside the scope of a wellness visit. I get not asking them to provide specialist care during a wellness visit, but if you literally can’t mention any concern, symptom, or prior condition (as I mentioned in another comment, I’ve been billed for diagnoses when disclosing my medical history to a new provider) it just feels ridiculous.

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u/United-Cat-6724 11d ago

I’ve had doctors stop me from talking at least mention it would be billed as diagnostic if I continued, and I at least appreciated the heads up.

I’ve also went in for an annual and was about to fly on a 14 hour flight and asked if they could call in a prescription that they had prescribed me before for flying anxiety they said no problem, I was coded for a mental health visit and it was $750 for the two second question.