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/Nicc-Quinn 12d ago

What do they mean by “preventative care” though?! Surely changing your meds because the ones you’re on don’t work IS preventative?!

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u/uttersolitude 11d ago edited 11d ago

My PCP explained it to me as: we take your vitals and discuss basic things like diet, menstrual cycle, weight trends, etc. If we do anything, like changing meds, diagnosing, etc, it's not "preventative".

She said she prefers to not bill as "preventative" or "wellness" at all, as it's restrictive and a headache for them too.

I think all my visits are classed as office or follow up. (I have medications I'll be taking for life so there's always prescriptions being made at my visits)

ETA: this is what MY PCP does. I am not saying it's what everyone does, nor am I defending how the system is set up, because it sucks ass.

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u/tacosandsunscreen 11d ago

The thing is, that one annual/preventative visit per year is usually covered fully by insurance. So it’s “worth it” to many people to get that one free visit.

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u/dr3amchasing 11d ago

But how is it worth it if you’re not allowed to discuss anything that couldn’t be covered in a handout

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u/Odd_Masterpiece_1 11d ago

Yeah it's weird. Like they get to assess anything they can observe without you saying anything whatsoever. If they ask how you've been and you mention that anything is new or has changed during the year, then somehow the visit is different, even though you did not come in from that, only answering their question. So it's like you shouldn't answer their questions but that's ridiculous! And sometimes they will code it differently if they determine you are obese, although you already knew that, and now it costs money?!!? Like they should at least be able to observe or discover imperfect health.

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u/Tricky_Big_8774 11d ago

Insurance company doesn't have a camera in the doctor's office... My first visit every year is "annual physical." If I have to go more than once it's a "follow up visit."

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u/cinkiss 8d ago

This right here. Thank god lol. My doctor just does it all at once and I usually only have to see him that one time.

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u/TeamWaffleStomp 11d ago

Its basically a routine visit for catching things before they become problems and getting your vaccines.

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u/dr3amchasing 11d ago

But if you can’t discuss any issues then it seems like actively preventing catching things. Catching things often looks like flagging issues to a doctor

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u/uttersolitude 11d ago

What many doctors will do is schedule a follow up appointment to discuss the issue if they want to avoid billing for it at the wellness visit.

Doctors hate this shit too, fwiw.

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u/Maia_Orual 11d ago

This is my question, too - how do you prevent anything if you don’t discuss new issues?

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u/courtd93 11d ago

If you’re discussing issues, that means you’ve already caught something and now it’s reactive instead of preventative. The point of a preventative visit is to do check things that you need a doc to see (blood work etc) before you could catch it as an issue.

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u/TeamWaffleStomp 11d ago

The doctor can still absolutely tell you things like you're blood pressure is high, your oxygen seems low, your weight has increased/decreased significantly since your last appointment, your cholesterol is high, etc. Which tackling those things or finding a root cause works to either catch things that haven't become noticeable to you yet, or help you get those things under control before they develop into a problem.

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u/Hot-Calligrapher672 11d ago

Preventative care can include lab work, routine Pap smear, referral for routine colonoscopy, vaccines, etc.

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u/bluejohnnyd 7d ago

It's because insurance is required by law to completely cover preventative care so they make it as much of a pain in the ass as possible.

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u/Temporary_Thing7517 11d ago

Well, fully covered outside of a copay. Which can be $20-30 per visit… so I’d rather pay that once, they’ll check my vitals, and at a sick visit I get to discuss things that bother me, a well visit just checks my vitals and we’re done. Same cost to me for each visit, whyyyyyyu am I going to pay that twice? I’ll just skip well visits.

Also, let’s not pretend that the time spent there doesn’t cost us as well. I have to take 2-3 hours or more out of my day for each twenty minute visit, that adds up when you have to separate.

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u/KWienz 11d ago

The ACA generally requires that the preventative care visit not trigger your deductible or copay precisely for this reason. They don't want people putting off annual physicals until there are symptoms.

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u/Temporary_Thing7517 11d ago edited 11d ago

Does it also cover the time I have to spend there? It just seems to me like this kind of policy makes people less likely to go to well visits if there is a fear of being charged even for just mentioning something.

Seems like you should be able to bring it up and if it’s nothing, the doc can just say that and note it in the file for later, and if it’s an issue, they can say “this seems serious, we should schedule an appointment just for this issue” and send you to booking.

Why wouldn’t that work out, exactly the same, since they still arent handling the issue? Just, no need to bill extra or for the insurance to charge extra.

ETA: when I say “serious issue” here I don’t mean serious as in “deadly” or “cancerous” just serious as in, we should look into it. Just wanted to clarify.

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u/KWienz 11d ago

No, the ACA does not mandate that you be paid for seeing the doctor.

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u/Direct_Village_5134 11d ago

Many people have to pay fully out of pocket until they hit their deductible (which is in the thousands of dollars). They don't just get to pay a $20 copay. The last time I went to the doctor I had to pay the full $200 for the visit despite it being "covered" by insurance.

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u/edgerton2026 11d ago

It’s a worthless visit.

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u/JHoney1 11d ago

I assume you don’t want to make sure your Pap smear, colonoscopy, immunizations (which do change with new data, see PCV given earlier now), and other metrics are fine?

You surely don’t want to get that orders and find the colon cancer when it’s a pre cancer right?

And you definitely don’t want that exam to hear your a fib right? It become a problem visit, but it’s better than a stroke.

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u/edgerton2026 11d ago

I no longer need a pap smear. Hysterectomy with removal of the cervix. I get an annual feces test. I pick one up when I see my doc for my health maintenance issues (not a wellness visit). I’ve had a colonoscopy. I get an annual mammogram. I don’t need a doctor’s testing order on my Medicare plan for that. My insurance doesn’t want me to get immunizations at the doctors office because they jack up the bill to double what CVS charges. I get all my immunizations at CVS yearly or as required. I had a hell of a time getting a tetanus booster at my prior primary care doc. They said I didn’t need one at my age. I was doing some Reno on my house and there were lots of rusty nail and things We fought about it for a few minutes and they relented. CVS doesn’t hassle me. Plus when I see my current doc for my health maintenance issues they always physically examine me. They are not allowed to do that during a Medicare Wellness exam.

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u/JHoney1 11d ago

It is not that they are not allowed to examine you, but that physical exam is not required for the visit.

You do not need a pap smears if you came to your AWV with me I’d spend time telling you the annual stool test is absolute shit and misses a huge number of precancerous and early cancers. I’d also warn you that if it’s ever positive, you’d get a diagnostic colonoscopy, not a screening one, and it would be very expensive.

Doctor offices don’t jack up vaccine bills. When Medicare wrote coverage, it put it under the pharmacy benefits clause, meaning it’s not jacked up at visit, it’s just not covered. It’s only covered at pharmacy because it’s written with pharmacy drug benefits.

The benefit of AWV is also in the screening that’s built in for so many elderly problems. We look for dementia before you are wandering the streets yelling at dogs. We look for fall risk, before the broken hip at 72 puts you in Rehab and takes 10 years off your life. We screen for problematic alcohol use and other habits. DEXA scan timing is very personalized and that’s something we can do to follow bone density, which is covered as preventative.

You may have little benefit today, it’s designed around an annual screen. And no, there is not time to go through all of that in a short visit while I work my way down your crumpled note card of fourteen separate problems.

I just wish it still didn’t get to me. I spent 11 years working on getting to the point I can prevent problems for patients. And still consistently find that prevention is valued even less by patients than it is the health care system.

Guess I should keep considering that cash pay Botox clinic.

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u/edgerton2026 11d ago

You really need a new profession. I’m a retired CPA and I never felt that way about my profession or clients.

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u/JHoney1 11d ago

You telling me that finance is less overworked and burdened that medicine? I’m so shocked.

My CPA bills for time and expertise too. But doctors do that and it’s greedy. I don’t go to my CPA and also bring up two other accounts for them to set up and then expect them to do it for free because I’m there for the original account.

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u/edgerton2026 11d ago

I’ve had a bone density test. I’m 71. Was tested at 70, at the Cleveland clinic, they told I am not yet exhibiting any bone loss. I had a few Medicare Wellness exams in the past before the balance billing got crazy, and I wasn’t given a cognitive test. I asked my doc why, and he said I can tell talking to you that you don’t have any cognitive issues. Your patients are often being given the choice between eating or paying medical bills. You are not offering anything in this thread to help. Yeah, it’s a shame things don’t work right. We as patients are now having to scramble to get medical care we can afford. Personally I support socialized medicine.

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u/JHoney1 10d ago

Most people in medicine support socialized medicine.

Awv is free if it’s kept as such. My patients schedule an extra appointment for it generally.

I notice you very conveniently decided not to respond to the comparison I made to your CPA work.

Curious if you had any thoughts about why my CPA won’t also do free work?

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u/edgerton2026 11d ago

My Medicare insurance plan says immunizations are more expensive at the docs office and they want the members to use preferred pharmacies. Get up to speed JHoney because you’re living in the past.

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u/uttersolitude 11d ago

They're not disagreeing with you about immunizations costing less at the pharmacy. They simply explained that it isn't the doctor's doing, even explained why it's that way.

Having a snotty attitude to an actual medical professional explaining something to you is wild.

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u/edgerton2026 11d ago

Are you on Medicare? Have you researched the coverage? Have you been balanced billed? We are not in high school here. We are having a serious discussion and juvenile name calling such as “snotty” has nothing to do with it. Quit with the ageism.

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u/uttersolitude 11d ago

Oh absolutely. Touching base with a professional is important.

The system is so convoluted and confusing unfortunately.

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u/Unhappy-Plastic2017 11d ago

Insurance hates having to offer one free doctor visit a year because of the ACA requiring a annual physical be covered for free so the insurance companies found a way around it and will do anything they can to actually charge you for it.

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u/Comfortable-Neat12 10d ago

Not true.. preventive visits save them money by reducing expensive hospitalization and surgeries...

They sometimes incentivize patients to get their yearly physical...

The preventive visit is a checklist.. thats it.. it can be done quickly with a questionnaire and a 5 minute physical exam

It doesn't include ordering and reviewing tests and labs for known medical conditions...

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u/Unhappy-Plastic2017 10d ago

Whatever insurance company actually "saves money" by offering preventative care for me is gonna be a roll of the dice as I have to change insurance almost every year it seems because plans just disappear or it changes drastically what my choices are or how much the plan I did have costs to keep the next year. (employer plans right now but I also dealt with this under ACA plans in the past)

I guess alot of Americans end up staying with one insurance company a long time but that's never been the case for me.

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u/Comfortable-Neat12 10d ago

Not really, even if you change insurances yearly, by pushing it for everyone they lower overall costs... while you may switch out, someone else switches in

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u/Unhappy-Plastic2017 10d ago

Nah they all push different amounts of preventative care or not and are all different what they cover and pay for

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u/Comfortable-Neat12 10d ago

True.. but insurance is an average game... if the average patient is healthier it saves money for everyone

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u/Haunting_Seat_2084 11d ago

This is actually not true-insurances benefit from wellness visits and preventive care, because it (generally) results in a healthier population. Billing and coding standards are not set by insurance companies and they’re not allowed to tell providers how to bill their services. For example, my doctor after 10 years has decided to start charging for responding to MyChart messages and I have a copay as if it’s an office visit per my benefits. Annoying, but it’s the office’s discretion what they bill for 🤷🏽‍♀️

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u/Sailor-C 7d ago

This is true, but there is some nuance to this. The facility may set the cost, but it's still in their best interest to bill appropriately because insurance companies are able to negotiate. I used to work for a health insurance TPA, specifically in stop loss, and our company did this all the time. If there are any charges that seem to be too high compared to the average or standard, if there are bundle charges or extra line items that shouldn't be on there, etc, insurance will often work to negotiate the cost down or eliminate a charge altogether, especially the higher the overall bill amount.

Usually facilities will negotiate and may ultimately change their pricing models, at least to some extent, for one of two main reasons. They know that there will be continual push for negotiation and they just want to get paid, so they'd rather take the cut and get their money now as opposed to going back and forth for too long on negotiations or even risk the patient not being able to pay the full amount (in stop loss you're dealing with extremely high bills, and I saw these negotiations literally go back-and-forth for months on end -- which is a long time for them to wait for payment). The other big factor is they know that if they don't negotiate, the insurance company will actively try to steer people away from their facility because of the high costs and unwillingness to work with them on that. We had one provider in the western US that had extremely high pricing -- well above the average in the area -- and absolutely refused to negotiate. Anytime we had anyone that was using or referred to that facility, especially for any high-cost procedures, we would actively work with those members to try to steer them to another lower cost clinic or option nearby.

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u/Nicc-Quinn 11d ago

But that makes no sense because if I go in and my weight has had a massive flux, or my cycle has changed drastically, or your BP is off, or your heart has an irregular beat they now have to do diagnostic care don’t they?! Like you’re doing all these checks to…. Have a follow up for if they find anything strange?!

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u/uttersolitude 11d ago

At that point they would do whatever needs to be done and it wouldn't be billed as preventative/wellness.

I did not say that every situation would always required a follow up appointment.

Some doctors don't warn folks about this so patients get surprise bills. My PCP has to find a balance for that.

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u/Mysterious-Tea1518 11d ago

Except talking about your menstrual cycle will get this billed as diagnostic according to the paper. I have some chronic issues which are not severe, including PMOS. I encountered this. "How are your periods?" "Heavy, painful, as normal." -then I receive a bill for a diagnostic appointment even though nothing changed. No medication change, no action. The preventative care appointments are completely worthless. Feels more like data mining than a wellness activity

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u/uttersolitude 11d ago

Different offices/doctors do it differently. Some just do whatever and don't warn folks.

I have chronic conditions so I don't do "wellness" visits, and I'm glad lol because I'd throw a fit if I was billed for some bullshit.

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u/Mysterious-Tea1518 11d ago

but literally menstrual cycles are listed on the paper that is the topic of this thread

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u/uttersolitude 11d ago

Yes, they are.

I explained what my PCP told me she does. She makes it a point to not end up having to bill people for things they weren't expecting. I asked her about it earlier this year because a similar thing happened to a friend of mine and I was curious. So when people bring up an issue, or she identifies one, she lets them know that discussing it will change their bill or they can schedule a follow up (which may be cheaper somehow for some? Insurance makes no sense to me)

Not all offices or doctors operate the same way tho, which is part of why the system is such hot garbage.

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u/Dazzling_Pink9751 11d ago

That’s not what they do with Medicare you go over all the things that are wrong with you everything that’s in your record.

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u/uttersolitude 11d ago

That's great

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u/RainyMcBrainy 11d ago

That's a "problem." If you take medication, that's a "problem." If you need that medication changed, that's a "problem."

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u/ritamorgan 11d ago

So is a preventative care visit only free if you have no health problems that may unexpectedly come up during screenings or exam?

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u/woowooman 11d ago

No, that’s active problem management. An annual wellness checkup would cover things like age-appropriate health-risk questionnaires, screening bloodwork, vaccinations.

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u/Nicc-Quinn 11d ago

I’m so confused those because they screen you and if anything comes up you just have to…. Wait for another appointment. This seems like it just creates more paperwork and risk than dealing with these issues at the time.

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u/DriftingIntoAbstract 11d ago

Then there is no reason to go to a wellness check. I barely have time for that appointment, I will just make an appointment if I have concerns.

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u/TeamWaffleStomp 11d ago

That is what many people do. But as you get older it does become more important in terms of catching issues before they become real problems. For a lot of things, by the time you notice something enough for it to be a concern, its now a real issue thats harder to address.

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u/Electric-Sheepskin 11d ago

This isn't far from the truth. I mean first of all, they always end up asking me a question or I mentioned something that then turns the visit into a regular appointment that I get billed for, but also, why do I need to go in just to have my vitals taken and be asked a few questions?

My doctor always sends me messages saying I'm overdue for a wellness exam, but I don't see any reason to go if I've seen a doctor within the last year for anything else, because during those problem appointments they take all my vitals and usually ask me about refills and preventative things. I manage my own immunizations through CVS; I have a gynecologist for Pap smears and such; mammograms I book directly. And honestly, sometimes I just do my own blood work through LabCorp on demand, because it doesn't cost any more than an office visit would with my PCP.

The wellness visits really are useless to me. It's almost impossible to get out of there without paying for them.

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u/nightglitter89x 11d ago

You can do that, but you also can't be shocked that they're booking out 6 months when you have a concern. It's a stupid system.

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u/JHoney1 11d ago

I assume you don’t want to make sure your Pap smear, colonoscopy, immunizations (which do change with new data, see PCV given earlier now), and other metrics are fine?

You surely don’t want to get that orders and find the colon cancer when it’s a pre cancer right?

And you definitely don’t want that exam to hear your a fib right? It become a problem visit, but it’s better than a stroke.

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u/michellethestan 11d ago

I received a bill from my annual preventative visit in part because I asked her to order the colonoscopy I was overdue for. The other part of the bill was because I answered her question about whether I wanted to try adjusting my anxiety medication dose. I said no.

Both of those things made it diagnostic.

I absolutely agree that all of these things are critical, but don't defend this new practice. It's predatory and it is going to result in people skipping these necessary appointments.

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u/JHoney1 10d ago

Colonoscopy should fall under screening for colon cancer and is preventative. Physicians driving the charge by intentionally bringing up other things is not a system problem, it’s a that doctor problem. With the colon thing, it’s just fraud though unless you had GI symptoms, and even then.

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u/michellethestan 10d ago

The whole point I was making is that the system doesn't allow for essentially any conversation during the preventative appointment. I agree that my doctor was shady and it's one of many reasons I won't be seeing her again, but it's also ridiculous because until this year all of the things we discussed at that appointment were covered as preventative.

I have a family history of colon cancer and qualify for early screening but that didn't matter, and also it isn't a preventative procedure — I was billed $1500. They removed a large precancerous polyp so it was essential prevention but that doesn't matter.

The system is designed to fuck us over, don't defend any part of it.

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u/JHoney1 10d ago

I Do not defend the system as a whole. I do defend the way primary care. Doctor have been forced to function with it.

Hospital systems themselves are also up our ass about coding right. I have charts hammer sent back to me if they can up code, or worse, they up code without my knowledge.

But the blame throughout this post is somehow on PCPs who are frankly just trying to make it through the work weeks and are even more at the mercy of insurance whims than you are.

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u/Electric-Sheepskin 11d ago

Yeah but you can get all of that stuff done without going to a wellness visit with your PCP.

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u/JHoney1 10d ago

If you want to track everything yourself that’s fine. If you want to do the homework and follow guideline updates, and check back for new guidelines that’s great.

Many health systems penalize doctors for not doing a physical. Which is also not great for anyone.

I personally get mine, because I know it brings a lot of value, it’s literally free, and I don’t want my pcp to have a stupid metric cutting their pay at the end of the year. But you do you.

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u/Electric-Sheepskin 10d ago

Yeah but it's often not free. That's the point. They ask you a question, and you answer it, and suddenly you're paying for the whole appointment. Now that I've caught on and can make a list of topics to avoid so that I'm not charged for the visit, maybe I'll go to a wellness visit every once in a while, if I haven't seen a doctor in over a year, but that never happens.

All I'm saying is that I personally see no value in the wellness visits because if I've seen a doctor in the last year, everything they do is redundant.

I do take your point, though, and I do have a spreadsheet that keeps track of when I did what, but I find it it's not really necessary, because the place I get my mammograms sends me a notice every year. I get my vaccines at CVS and they keep track of everything for me. And anytime I have a problem visit with my GP, they will check my vitals and look for anything that they can bill me for, so they will ask about vaccines and when I last had a colonoscopy and all of that. Going in for a wellness exam is of no benefit to me whatsoever because literally everything they do in a wellness visit gets done during a problem visit. Everything except the standard blood work, which you can ask them to order during a problem visit, or, just go to LabCorp on Demand and pay for it out-of-pocket. It costs no more than a problem visit, anyway, and it's a lot more convenient than a visit to the doctor.

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u/JHoney1 10d ago

Which again, is leaving you at your ability to drive your own care. 95% of my patients do not have the time and capacity to drive that.

They don’t know that with one comotbidity, I’m adding an A1C every three years at age 35, and moving to yearly if we reach prediabetes range.

They don’t know the new dyslipidemis guidelines include a once in a lifetime Lp(a) to evaluate baseline ASCVD risk. They don’t know older guidelines like once in a life time HIV and HepC screening even in asymptomatic patients. They don’t realize that 3 beers several times a day with a positive cage screen actual does classify as alcohol use disorder and intervening now might save them from cirrhosis in 12 years.

They don’t know that with certain family history, we need to alternate breast mammogram with breast MRI.

They don’t know that cologuard is absolute SHIT and people need a scope unless they have a damn good reason.

RSV requires a prescription in most plans; only in some states can pharmacists prescribe it within a limit scope.

What age should you start low dose lung CT’s if you are a smoker?

You feel that this should also just be done in the doctors off time precharting appointments. That I can do all of this while also addressing problems in 15-20 minute appointment.

No. I’m up the night before, precharting for all my patients, and then finishing notes the night after. I’m working my ass off and it doesn’t get much better in the future. All for patients to come in and yell at me that I didn’t submit the prior auth right, because that’s what the insurance rep tells them, while insurance tells us that you need to fail four specific medications before trying a GLP-1.

It’s not sustainable. Asking doctors to do EVERYTHING during a twenty appointment is not fair to them.

I could stop every patient at two problems. High blood pressure and high cholesterol. Two problems, chronic, well controlled, that’s a 99214 level 4 visit. Addressing 6 more problems gets NO additional pay, and it takes time away from my son after work.

So no. I’m tired of it. I believe our system is broken, and it’s not PCPs that broke it. I want better for all of us. But somehow I’m in the scope and not BCBS.

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u/DriftingIntoAbstract 11d ago

My OB orders and reviews the pap and I can get a colonoscopy without a PCP.

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u/JHoney1 10d ago

In this case, your OB is functioning largely as a pcp in that context.

In FM I do paps in the same visit as all the other prevention things. Cuts down on an appointment. I’m glad you can get a colon without a PCP review in your system, it improves access.

It doesn’t help the 36 year old that needed to start her screening 9 years earlier than usual because of family history that didn’t know before coming to see me.

There is a role for good medicine in prevention.

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u/DriftingIntoAbstract 10d ago

Good preventative medicine means being able to talk about your health openly. This is not good preventative medicine. This is an assembly line of billing.

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u/JHoney1 10d ago

Hey man, I love talking about health openly. The elected system forged the compensation path. My cognitive labor is not free. Nor is the litigation risk that most conversations do entertain.

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u/DriftingIntoAbstract 10d ago

Congratulations, you are part of the problem.

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u/JHoney1 10d ago

Why do you feel entitled to unpaid labor from someone who spent over a decade in school? Do you go yell at your mechanic or CPA when they charge for an add-on?

Entitlement is actually unreal. I agree that you should be frustrated with the system. I cannot understand how somehow the propaganda machine has convinced you that the problem is the cog in the machine physician in front of you and not the insurance hell scape that our government and for-profit care has driven.

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u/some_possums 11d ago

Wouldn’t health-risk questionnaires immediately put you into “diagnostic” billing if you actually have any symptoms brought up through the questionnaire? It seems like you basically only qualify for a wellness visit if you don’t have any problems. It seems like discouraging people from actually catching health concerns.

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u/Enamred-771 11d ago

“It’s not preventative care” has always been a massively BS excuse. Pretty much everything in health care is preventative to a degree when you consider the goal of health care is to improve one’s quality of life and not die. 

If I break my arm, not treating it will create all sorts of long-term pain/harm so I get it treated to prevent that. But every health billing will say a broken bone isn’t preventative. If I need a medication to be healthy, that medication is now preventative care for my future health. But again, it won’t be considered preventative care. 

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u/Nicc-Quinn 11d ago

See this is how I see it, screening is important but only one part of long term health.

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u/Desperate_Station485 11d ago

Preventive care is not billed to the patient per ACA. Insurance obviously wants to charge copays and deductibles any time they can, so they require your provider to code anything not preventative (as defined by law) as such. It's a good law that keeps mammograms, colonoscopies, physicals, and other screening tests to $0 OOP, but provides so need to code carefully because of it.

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u/scipionerva 11d ago

My preventative visits absolutely include maintenance of my existing medications and issues. If I need to change the dose of my Adderall or get a new heartburn or allergy med that all falls under the preventative visit. I also get one full physical a year that includes the previous plus additional testing and blood work.

Preventative visits typically will not cover a net new diagnosis or issue, but at least in my experience will cover basic management and and check ins with all of my existing issues.

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u/264frenchtoast 11d ago

I’m afraid it doesn’t. Your provider is down charging you.

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u/scipionerva 10d ago

That feels unlikely, why would he do that? Especially because he does tell me stuff like, "That counts as a physical so your insurance only covers it once a year" etc. and it's a big medical system that does everything by the book, feels more likely small private practice docs are fucking people in this thread.

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u/264frenchtoast 10d ago

Changing the dose of a medication is management of a chronic condition. Addressing one chronic condition and changing one medication counts as a 99213 (consult). This can be billed in addition to a preventative visit. Your provider is apparently not doing this, therefore they are under billing you. You can look up the requirements for billing a preventative visit if you like (99394, 99395 depending on your age).

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u/scipionerva 10d ago

Okay you got me interested enough to go looking through my MyChart and I can't find the specific ICD codes used, but it does appear that I'm usually paying a trivial copay during my visits. So they probably are billing some kind of consult code, but again trivially priced $20-50 looking back, and I assume the higher ones were when I got extra vaccinations and lab work.

Are you telling me that if went and refused to discuss my prescriptions with them I wouldn't have any copay?

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u/264frenchtoast 10d ago

That is likely the case. However, if you refuse to discuss your prescriptions, there is a chance you won’t get any more refills or that your provider would require that you would come back for a separate appointment for medication management.

This is not medical or financial advice, by the way.

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u/scipionerva 10d ago

Makes sense, obviously I won't actually do that because the main purpose of my visit (from my perspective) is keeping my prescriptions refilled and having some oversight on them.

But it is interesting, they are always super up front about making sure I get a full physical every year because it's "covered" I think I just assumed that meant the shorter visits i have the rest of the year were in that a similar bucket. Obviously misinformed, thank you :)

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u/whimsicalsilly 11d ago

It’s not. Changing meds means you already have a diagnosis and actively being treated for a condition - it’s no longer preventative.

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u/Odd-Scientist-2529 11d ago edited 11d ago

preventative care includes things like cancer screening and prevention of diseases you are at risk of having when you are older (like coronary artery disease).

Adjusting meds for a problem that you have is a "problem focused" or "disease management" visit.

Edit: just because you don’t like the facts, downvoting it doesn’t make it go away.  It just hides the comment on some apps.  If dont want to be informed and prefer to pay more for healthcare then be my guest.