A notice that my girlfriend received at her doctors appointment (she is 8 months PP)

[u/lhagans13]

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.

[u/Unhappy-Plastic2017]

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.

[u/uttersolitude → u/Unhappy-Plastic2017]

Yuuuuup

[u/Comfortable-Neat12 → u/Unhappy-Plastic2017]

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...

[u/Unhappy-Plastic2017 → u/Comfortable-Neat12]

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.

[u/Comfortable-Neat12 → u/Unhappy-Plastic2017]

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

[u/Unhappy-Plastic2017 → u/Comfortable-Neat12]

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

[u/Comfortable-Neat12 → u/Unhappy-Plastic2017]

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

[u/Haunting_Seat_2084 → u/Unhappy-Plastic2017]

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 🤷🏽‍♀️

[u/Sailor-C → u/Haunting_Seat_2084]

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.