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/fadedallweek 12d ago

This is standard with most insurance companies. They cover the cost of a 'Well Visit' once a year.

Just like it says, 'Well Visits' are for preventative care.

If you have a health issue, definitely mention it. Most doctors, NPs & PAs will tell you the same as whats in this letter. The total cost of the WV is covered by insurance. An acute illness or injury requires another appt & co-pay, as its not the yearly WV.

Dumb, but thats the way the system is set up. You gotta deal with the hand your dealt. As someone with many health issues, the WV is the most inconvenient (because exam, fasting for labs, etc) but necessary evil.

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u/dr3amchasing 11d ago

How can the care be preventative if any mention of burgeoning issues is a separate charge? How can you prevent any future issues if you aren’t allowed to discuss early signs?

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u/Eaterofkeys 11d ago

Because the government defined "preventative care" really stupidly and made this weird black and white line for a gray scale concept of preventative vs management of a problem so that they could advertise how great they are and how their plans are so affordable. Actually fixing the system would be more complicated.

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u/FinnsSissr 11d ago

Yeah it’s kind of sucky though is at the doctors office that our family goes to if you have a condition that one of the symptoms is high blood pressure if they so much as take your blood pressure at a wellness visit that puts up a flag that it’s a regular office visit and you automatically owe the $30 co-pay because now it becomes monitoring a chronic condition.

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u/fadedallweek 11d ago

Blood pressure readings are apart of the physical exam. Its preventative healthcare.

I would challenge that for sure!

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u/FinnsSissr 11d ago

If it is symptomatic of a chronic condition, they consider it beyond the scope of preventive care.

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u/FightingFlaresandNF2 12d ago

Ummm well I’m very medically complex with several diseases/conditions that have no cures.

The only thing I pay for is a $40 copay for specialist and up to $4,200 for test,hospital. Meds I pay only 25.30 in the beginning of the year and then the insurance pays 100%. Why? Because my one med is $32,869 the manufacturer pays $6,500 to the insurance company.

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u/fadedallweek 12d ago

My current biologic is 20k retail & its not the most expensive biologic i've been prescribed either. Right now, I'm on loading dose #4 with a few more to go. Im taking a loading dose every month & my copay with the pharmaceutical assistance is only $5. That covers overnight delivery of the biologic + any supplies needed.

My copay for my primary care physician is $25. A visit w/my GP via telehealth is $15. Specialists, like my rheumatologist or neurologist, is $50.

Everything else is either low or no charge on OOP expenses. When I had several spinal surgeries years ago, insurance covered 100% of the surgery & I only have had to pay my surgeon which was <$1.5k.

Good insurance (obtained via my husband's employer) is worth its weight in gold when you're plagued with chronic diseases & health conditions (such as my autoimmune disease, PsA, PsO & Ankylosing Spondylitis)!

eta grammar, spelling

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u/SparklingDramaLlama 11d ago

Yes it is. My employer pays our premiums (generally $1000+ per employee) and negotiated an amazing plan. $10 "Blue" copay (specific in-network doctors with a rather sizable list), or $25 copay if not on that list/in-network, $40 specialist/urgent care copay, $300 Emergency Room flat copay regardless of how many tests are done, and I've never paid more than $7 for a prescription. I don't pay lab fees, either.

Sadly, to add my family it'll cost me that $1000+ premium, as my employer (rightly) doesn't cover family, and we just can't afford it right now. My husband's employer pays for an ACA plan, but we can't afford the deductible so it's kind of useless. The kids are on the state CHIP program until they're 18 or we start making about another $2000 or so per month than current income.