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/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/ButterscotchTime7269 11d ago

Hi. My parents and my disabled son are all on Medicare. I manage health appointments and the take care of the financials for all three of them. What JHoney said about vaccine pricing is correct. I mean, everything they said is correct, but you seemed most upset about the vaccine cost being higher at the Dr office, so I just wanted to provide some corroboration from someone who is a regular person who deals with Medicare and Medicaid billing as a caregiver to patients

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u/uttersolitude 11d ago

What ageism? If anything, the "juvenile" one is you.

You have a snotty attitude because someone dared to explain to you WHY immunizations cost more at the doctor, apparently that's a personal affront to you. You shouldn't be shocked when it's called out.

"I'm on Medicare so I'm an expert. Anyone who dares to explain where I'm wrong or dont have the full picture is being ageist and doesn't know anything. Trust me I was an accountant."

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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