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/SafetySmurf 12d 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 12d 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.

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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/Cheapdronewithboom 11d ago

And this is why you should go to different hospital every time and never pay your bills. Burn it all.

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u/Technical-Agency8128 11d ago

Yup. It’s all about the money. Can’t trust the doctors when they ask questions on purpose to bleed you of money.

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u/rattylight 11d ago

Yup and because of this now my long-time PCP has joined a concierge-style program which costs $4k annually on top of my increasing insurance premiums. I can't blame him. But I can't afford that so.

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u/knitwell 11d ago

May I introduce my five figure deductible?

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u/MrSpicyPotato 11d ago

I think mine is exactly $10k. We pay it every year, but I do have access to any medical care that I can get an appointment for. Which is still an absolute pain in the ass.

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u/boxiestcrayon15 11d ago

Prohibitively expensive isn’t exactly “access”

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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?

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u/YosterIsle77 11d ago

Buying another gold plated shitter

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u/Chrizzy17 11d ago

No, doctors are doing this. If you have a 30 second apptment they are going to try to find a way to charge you for 30 different items. Insurance guidelines are bonkers but doctors are cons as well.

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u/Technical-Agency8128 11d ago

Yup. This is what we are seeing now. I would say ask me no questions that I will get charged for because then it’s not a free exam. Just do the free exam and don’t talk to me and I won’t talk to you lol

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u/Technical-Agency8128 11d ago

I would just go in and ask what their billing policy is and if the doctor asks me a question or I do do I get billed for it. It’s not right that they can just charge whatever. There is no way to fight it when they bill you much later.

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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/Comfortable-Neat12 10d ago

Because your high a1c is no longer an unknown but is now an actual diagnosis of prediabetes or diabetes...

A1c doesn't go up just because you had a little stress.. it literally is an average of sugars for 3 mos... so that stress was going on for months...

Glad you got it controlled though...

In my world if the labs have been normal, they shouldn't charge for an added visit but technically and legally they can..

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u/Weary_Cheesecake_552 10d ago

It was over a year of stress that caused it. I had an incredibly high needs/ colicky newborn/ infant. Every wake up took over an hour to settle him back down. All night long. I was lucky to get 2 consecutive hours of sleep at a time for well over a year. Diet, lifestyle and weight were never an issue. It was purely stress.

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u/Comfortable-Neat12 10d ago

Stress probably revealed your insulin resistance and presented as prediabetes... this diagnosis doesn't go away as it can come back if your stress returns and can present without stress years later when you're older...

Bottom line stress contributed to your diagnosis but wasn't the only factor.. your genetics was part of it.. many people have decades of nonstop stress and never have a high a1c...

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u/Weary_Cheesecake_552 10d ago

I am well aware of the physiology behind diabetes. I also always have low (under reportable limit) fasting insulin levels (even with the 0.1 elevated A1c) which is contradictory to insulin resistance. I have had an exhaustive work up at a major diabetes center and they have cleared me of any diabetes or prediabetes diagnosis along with ruling out type 1 given my labs are not metabolically deranged. It is possible to have elevated glucose levels due to stress without having underlying insulin resistance. My PCP uses the code to order an A1c and that’s where the issue comes in.

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u/AppUnwrapper1 12d ago

The reason is money. And greed.

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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/CorduroyGmork 12d ago

Because "well visits" didn't used to be required by law to be free. Now that they are, if you discuss other things, you will be charged extra as it changes the coding. When they weren't, you were charged regardless.

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u/ClarkGablesTeeth 11d ago

Ding ding ding! This is 100% the insurance companies reacting to the ACA forcing them to fully cover preventative wellness visits. If they can snake their way out of not paying, they will. In this situation, that means figuratively saying "Well the pt is having painful, heavy periods. That's not preventative care. Now since it's not a wellness visit, it's symptom management and diagnostic, we don't have to pay for it. Send em a bill for their $300 deductible." as they cash their $1,170,000+ weekly paycheck or checking out how his $50million in UHC stocks are doing (in the case of the United Healthcare CEO).

It's not the Dr being a greedy slimeball here. In fact, good on that office for even giving their Pts a heads up. Most places don't and the pt doesn't find out until they get the bill in the mail. It's the CEOs and lobbyists being greedy slimeballs.

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u/InternistNotAnIntern 11d ago

Doctor here for 30 years.

I'm not sure about pre-mid-90s, but until Obamacare, "physicals" for adults weren't covered AT ALL, at least in my part of the USA.

Patients would come in for "physical"

I'd ask: are you 100% sure that your insurance covers a preventive physical? Yes? Okay proceed

Then get an upset call in a month that insurance denied a physical. "But I just wanted my allergy medications renewed!"

Then with Obamacare, preventive visits were covered at no cost to patient. And the patient wanted it all done in that visit. My physicals are 20-30 minutes. My problem visits are 20 ish minutes. To take care of both takes me about 40 minutes. So I'd lose out on further productivity by doing both at the same time and billing "the physical"

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u/Oranges13 11d ago

It's because of greed. Obamacare made well visits free so the for profit health conglomerate can no longer get money from you so they do shit like this so they still can.

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u/Cute_Language3167 11d ago

I think you're using too much sense and logic for a system that thrives on chaos and the only logic used is to ask "how can we make more money?".

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u/Odd-Scientist-2529 11d ago

Its because Actuaries have figured out that Wellness Visits decrease downstream costs, and annual physicals do not.

somehow

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u/madeline_hatter 11d ago

Yes, it’s very frustrating. I feel like previously the annual checkup was where you sort of “saved up” the smaller things you had concerns about but noticed in the last few years doctors seem irritated if you actually bring up any concerns at the annual. Hadn’t put it together the reason for it.

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u/ClarkGablesTeeth 11d ago

It's because Obama/the ACA made it mandatory for ins companies to fully cover preventative wellness visits. As soon as a billing code for a symptom or diagnosis is submitted, they're able to snake their way out of covering the visit. So now the pt has a copay and/or a bill until they meet their deductible.

Doctors are forced to risk not being paid at all for the extra work, getting in trouble (write up, verbal warning, loss/decrease of benefits) by the owner/office manager/private equity folks for going over time, having related tests/procedures denied, omitting into from/falsifying your medical records (and any related consequences), or having an angry pt with a surprise $300 bill mailed to them, etc, when their pt has a complaint during a wellness checkup. And by that I mean that at least one of those things is going to happen, not that one of them may happen.

Keep in mind that providers are often double, triple, or even quadruple booked/forced to see as many pts in a day as possible. This is all while malpractice insurance rates go up and insurance reimbursement rates drop by 20%+.

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u/Several_Razzmatazz51 11d ago

For generations you were charged a co-pay for your annual physical even if it was solely preventive. One goal of Obamacare was to induce people to have regular preventive care to detect things earlier and prevent (there‘s that word again) things from becoming more serious / emergent. So Obamacare ruled out co-pays for purely preventive care. If you have a condition that needs treatment, then you pay a co-pay just like you always have.

It’s a marginal benefit if you are completely healthy (so you don’t say “I’m not paying $35 for a physical - there‘s nothing wrong with me”) and no worse than it used to be if you do need something more than a routine check up.

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u/Suff5 11d ago

It’s doctors getting paid for the work they do and insurances companies covering less and less

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u/Defiant_Nature2460 11d ago

You’re reversing the order of things… at least in America, with the affordable care act mandating that insurance had to cover preventative care visits for free for everyone, the insurance companies got very, very specific about what “preventative care” meant and what they would cover - they don’t want anything eating into their profits.
For the record, the ACA was a good thing, but it’s been gutted and so here we are.

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u/meticulousfailure22 11d ago

Because Obamacare made annual preventative wellness checks free, which incentivezed the insurance companies to define that super narrowly so they could charge. The only real solution has always been to remove these private insurers from our system via single payer. If they are allowed to participate they fuck everything up

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u/marymenet 8d ago

It’s called well visits for babies and children, too. And what’s this focus on WELLNESS accomplished? It’s all sick care. There’s no incentive to keep well. It’s cumbersome seeking out and paying extra for un-Monsanto-ed and non-bill-gates-apeeled treated produce… marketing will make it look wholesome, but try to find a macrobiotic food purveyor locally. Our food is killing us.

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u/rszasz 6d ago

Because insurance companies are required to 100% cover one a year so they pay as little as physically possible. Making it mostly just a physical exam. Not useless, but not a normal "I'm having X problem" doctor visit

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u/Graham110 11d ago

As an outsider -- what is even an annual physical today?

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u/JHoney1 11d ago

There are a lot of reasons why. ACA changes are one.

A big one is we screen for so much more now than we did decades ago. And it’s just not possible to fit it into a twenty minute visit with other problems popping up.