Keep your mouth shut!

[The Walk of the Penguin Mich]

Yesterday, I was going through mail.  I had 2 bills in there, one where the first bill I received was 3/23 for a 5/22 doctors appt and another bill about the same time for a 7/22 appt.  We left 12/22, and I had assumed all bills were covered, the May appt was a well woman check, the July one for my BP meds. No problems in either were discussed. 

Medicare denied my well woman’s check up and called it a focused appt, so isn’t covered.  The clerk read the notes.  ‘Patient mentioned she lost 35 lbs and is hoping to keep it off’ and ‘change in meds discussion’.

The change in meds discussion was about an already prescribed med I would continue, but ‘could he please write it for 3 months at a time rather than one?’.  

The first point was a chit chat going on while my feet were in stirrups while my nether regions were being probed.  I in no way asked for any advice as to how to lose weight, or keep it off.  He gave no advice, just commented that it could be difficult on a cruise ship.  

Moral of the story?  Do not say anything to your doctor.  Even if you are not asking for advice, any talk will be considered a discussion or advice, regardless how frivilous.  

I have no idea why my second bill was denied, but probably comparable.  After getting off the phone with the first office, I was too pissed to do the second and keep my composure.

[weltschmerz]

What's a focused appointment?

[The Walk of the Penguin Mich]

Jun 24, 2023 21:49:39 GMT -5 weltschmerz said:

What's a focused appointment?

When you go into the doctor with a specific issue.  

For one of mine, it was a well woman’s visit, for the other it was a yearly face visit to get my BP meds. I had no issues for either.

[minnesotapaintlady]

Jun 24, 2023 22:14:12 GMT -5 The Walk of the Penguin Mich said:

Jun 24, 2023 21:49:39 GMT -5 weltschmerz said:

What's a focused appointment?

When you go into the doctor with a specific issue.  

For one of mine, it was a well woman’s visit, for the other it was a yearly face visit to get my BP meds. I had no issues for either.

Yeah, I posted something similar last year after getting a medical visit charge at my annual "free" physical because I pointed at a weird spot on my leg when he asked me if I had any questions or concerns.  He didn't even do anything about the spot.  Just made me an appointment with dermatology which I could have just done myself.

[weltschmerz]

Jun 24, 2023 22:14:12 GMT -5 The Walk of the Penguin Mich said:

Jun 24, 2023 21:49:39 GMT -5 weltschmerz said:

What's a focused appointment?

When you go into the doctor with a specific issue.  

For one of mine, it was a well woman’s visit, for the other it was a yearly face visit to get my BP meds. I had no issues for either.

So, if you go for a check-up, your expensive insurance won't pay? That makes no sense at all.

[raeoflyte]

They actually have this posted in all.of the exam rooms about your physical in my new doctor's office. I'm on new meds and have had new history since seeing her so I don't even feel like it's possible, but thankfully this year I've already hit my deductible.

[pooks]

My Dr has signs posted in the room, that if we discuss anything it becomes a diagnostic appointment and may not be covered by insurance.  Our family now jokes that wellness appointments are to discuss how "well" we are doing, nothing else.  Useless. 

[NomoreDramaQ1015]

DH had this happen before. They said if he wants to ask questions he needs to make a separate appointment.

WTF is the point of a yearly wellness check if you can't discuss your health?

And people wonder why up until now I didn't bother I got all my wellness stuff done through work.

Another fun thing they do now is if you only see your physician once a year you get slapped with a $250+ new patient fee every time even if it's someone you've used for years.

The spin is they want to "encourage you to build a relationship with your doctor"

Dude I'm not dating my doctor I'm not paying for an office visit just to chat over coffee.

This is punishment for me being healthy and not being able to milk my insurance.

[minnesotapaintlady]

Jun 25, 2023 10:16:00 GMT -5 pooks said:

My Dr has signs posted in the room, that if we discuss anything it becomes a diagnostic appointment and may not be covered by insurance.  Our family now jokes that wellness appointments are to discuss how "well" we are doing, nothing else.  Useless. 

Right?  I'm questioning the purpose of annual exams myself.  Sure they're free, but why waste my time and the insurance company's money to take my height, weight and blood pressure? 

[TheOtherMe]

Sounds like I will be making a 2nd appointment about my blood clots ASAP at my Medicare wellness exam tomorrow.  I was told it had been so long since my last one that she wouldn't see me without one.

That is quite irritating.  I was hoping to get started on getting this figured out. 

[The Walk of the Penguin Mich]

I have an appt in Sept for a wellness exam.  I have no problem putting in face time in order for them to see that I’m ok and my BP meds are holding me in check so that I can get them for the next year.  

But now that I am aware of this stupid policy, you can make damn sure that no information is going to get volunteered.  

I guess next time I’ll just mention which of the babies plastered on the ceiling look like trolls.  That certainly can’t get me in trouble while in stirrups…..right?

[TheOtherMe]

I just went in and made an appointment for Friday to discuss my medical issues.  My mouth will be closed on those at tomorrow's wellness exam.  That is how they have it coded, so thank you The Walk of the Penguin Mich.   I will just have to wait a few more day to hopefully get some answers.

[TheOtherMe]

I hope I can ask about a medication that was supposedly prescribed at an appointment and the drug connected to the office did not give me the medication.  That's all I will take with me tomorrow.

[The Walk of the Penguin Mich]

Jun 25, 2023 11:12:27 GMT -5 TheOtherMe said:

I hope I can ask about a medication that was supposedly prescribed at an appointment and the drug connected to the office did not give me the medication.  That's all I will take with me tomorrow.

I dunno about that.  The medication I was prescribed by this doc I asked for a 3 month refill rather than a 1 month refill.  According to them, that meant we discussed my medications and becomes a focused office visit.

[saveinla]

For me its only an issue with my PCP.

My OBGYN is really good and she sets aside 10-15 mins after the exam to ask if I have any questions or concerns, addresses them and still bills it as a well visit.

[minnesotapaintlady]

Jun 25, 2023 11:16:02 GMT -5 saveinla said:

For me its only an issue with my PCP.

My OBGYN is really good and she sets aside 10-15 mins after the exam to ask if I have any questions or concerns, addresses them and still bills it as a well visit.

Same.  Only my PCP is guilty and it's at the same hospital.  I told my OBGYN about my panic attacks last year and how I had been swiping Ex 2.0's left xanax the past decade for the 2-3 times a year I needed them and she wrote me a scrip for me for something else. That never got billed as a medical visit either.

[TheOtherMe]

Jun 25, 2023 11:15:26 GMT -5 The Walk of the Penguin Mich said:

Jun 25, 2023 11:12:27 GMT -5 TheOtherMe said:

I hope I can ask about a medication that was supposedly prescribed at an appointment and the drug connected to the office did not give me the medication.  That's all I will take with me tomorrow.

I dunno about that.  The medication I was prescribed by this doc I asked for a 3 month refill rather than a 1 month refill.  According to them, that meant we discussed my medications and becomes a focused office visit.

Won't mention until Friday

[Artemis Windsong]

Ruh Roh.  My Medicare wellness check up in May.  I focused on my left knee, got an x-ray and referral to orthopedist.  Script for a different statin that I am getting along with so far.  Passed on the pelvic and breast exam.

[Opti]

Jun 25, 2023 10:30:48 GMT -5 minnesotapaintlady said:

Jun 25, 2023 10:16:00 GMT -5 pooks said:

My Dr has signs posted in the room, that if we discuss anything it becomes a diagnostic appointment and may not be covered by insurance.  Our family now jokes that wellness appointments are to discuss how "well" we are doing, nothing else.  Useless. 

Right?  I'm questioning the purpose of annual exams myself.  Sure they're free, but why waste my time and the insurance company's money to take my height, weight and blood pressure? 

I think its to get a status to refer back that is updated once a year. I still have some homework from my intake visit like more bloodwork. Both the doc and I think it was momentary, and I'm guessing its from clearing out my freezer of various ground beef packages which are now gone. 

Need to set up other things too and will see if I can get that done next month. 

[Pink Cashmere]

My PCP that retired a couple years ago used my annual visit to run blood tests and follow up on any issues she was aware of. It was still billed as a wellness visit. But she also did the follow up thing whenever I saw her. She wasn’t one of those Doctors that would only discuss the specific thing you made the appointment for. She would look through my chart and bring up things herself, and I was always free to ask questions myself about other concerns. Those are some of the reasons I really miss her. 

[The Walk of the Penguin Mich]

Jun 25, 2023 20:39:21 GMT -5 Pink Cashmere said:

My PCP that retired a couple years ago used my annual visit to run blood tests and follow up on any issues she was aware of. It was still billed as a wellness visit. But she also did the follow up thing whenever I saw her. She wasn’t one of those Doctors that would only discuss the specific thing you made the appointment for. She would look through my chart and bring up things herself, and I was always free to ask questions myself about other concerns. Those are some of the reasons I really miss her. 

I don’t think the doctor selects how they bill, how they bill is reflected in his notes.  So I am free to ask questions, but it changes how it’s billed to insurance.

[wvugurl26]

It's possible that pink's prior PCP instructed billing staff to bill as a wellness visit despite anything in the notes. It's very dumb. Some areas might have more staff but around here it takes months to get the wellness visit scheduled. Good luck getting that second appointment for concerns scheduled within the next six months.

[NomoreDramaQ1015]

Jun 26, 2023 7:34:29 GMT -5 wvugurl26 said:

It's possible that pink's prior PCP instructed billing staff to bill as a wellness visit despite anything in the notes. It's very dumb. Some areas might have more staff but around here it takes months to get the wellness visit scheduled. Good luck getting that second appointment for concerns scheduled within the next six months.

And if you don't you'll get a $250 new patient fee!  Every single freaking hospital here now charges one if you aren't coming in every six months.

Yet they also bitch about "wasting their time" for scheduling appointments when it isn't urgent or chronic.

Well I'd consider a completely separate appointment just to chit chat with you when we could have done it during my yearly wellness visit to be "coming in when it isn't needed".  I have no chronic issues that need followed up on.  There is absolutely no reason I need to be going to the doctor every six months.  

So which is it? 

I feel like PCP offices lost a shit load of money with the advent of urgent care and minor care clinics popping up and it backfired on t hem insisting you go there for things like a UTI or a kid's fever in the middle of the night and only go to your PCP for regular chronic issues and your wellness visit.  Now they have to find a way to recoup all that money and pay for the waterfall wall in their office waiting area. 

[Knee Deep in Water Chloe]

For mine in January, I was billed for two different appointments--which was a surprise when I received the statement. The bill said I'd had two appointments on that day. I called the billing office to have the second appointment removed. Their explanation: At my scheduled well check, I asked a question. Apparently that was fine. But then, THEN! I asked a second question. That caused the billing office to create a second  appointment in the system, which, of course, was not a well check appointment. I guess it did save me the time of going to another appointment, but sheesh!

[TheOtherMe]

I've already scheduled the 2nd appointment for Friday.  That's only because I go to a small clinic in this area.  It's part of the larger clinic which had no appointments for months.

Since no blood work was ordered for today's appointment, I know there will be that to be done.  That part I don't understand.  There was time to do bloodwork from the time I made the appointment until today so if I didn't have other issues, that would be a waste of my time.

I decline the pelvic and breast exam, too, so this is just a charade as far as I'm concerned.  How can she renew maintenance meds without the blood work?

[The Walk of the Penguin Mich]

Jun 26, 2023 8:28:18 GMT -5 TheOtherMe said:

I've already scheduled the 2nd appointment for Friday.  That's only because I go to a small clinic in this area.  It's part of the larger clinic which had no appointments for months.

Since no blood work was ordered for today's appointment, I know there will be that to be done.  That part I don't understand.  There was time to do bloodwork from the time I made the appointment until today so if I didn't have other issues, that would be a waste of my time.

I decline the pelvic and breast exam, too, so this is just a charade as far as I'm concerned.  How can she renew maintenance meds without the blood work?

Interesting point. My appt in Sept is to renew my meds and in the past, my BP meds have been held hostage for getting it done (well, a 90 day supply has….they renew for 30 days and it wasn’t that I didn’t do the blood work, multiple copies of my results were delivered but their staff didn’t bother putting it in my file).  I had to hand deliver them to the doctor with the 6 month date before I finally got a 90 day script).

[daisylu]

Good to know. I have a visit with a new gyno tomorrow.

[TheOtherMe]

I will get answers on the maintenance prescriptions this afternoon.  I don't think she will refill them without bloodwork, which she will order done.  Since I'm going in on Friday, it's not much of a delay.

[Cookies Galore]

Jun 26, 2023 7:38:48 GMT -5 NomoreDramaQ1015 said:

Jun 26, 2023 7:34:29 GMT -5 wvugurl26 said:

It's possible that pink's prior PCP instructed billing staff to bill as a wellness visit despite anything in the notes. It's very dumb. Some areas might have more staff but around here it takes months to get the wellness visit scheduled. Good luck getting that second appointment for concerns scheduled within the next six months.

And if you don't you'll get a $250 new patient fee!  Every single freaking hospital here now charges one if you aren't coming in every six months.

Yet they also bitch about "wasting their time" for scheduling appointments when it isn't urgent or chronic.

Well I'd consider a completely separate appointment just to chit chat with you when we could have done it during my yearly wellness visit to be "coming in when it isn't needed".  I have no chronic issues that need followed up on.  There is absolutely no reason I need to be going to the doctor every six months.  

So which is it? 

I feel like PCP offices lost a shit load of money with the advent of urgent care and minor care clinics popping up and it backfired on t hem insisting you go there for things like a UTI or a kid's fever in the middle of the night and only go to your PCP for regular chronic issues and your wellness visit.  Now they have to find a way to recoup all that money and pay for the waterfall wall in their office waiting area. 

I've never heard of a new patient fee! I had to visit my PCP at a different location once because it had been a few years since I've seen him and "he wasn't taking new patients" at the office I've been going to my entire life. But I still got to see him, re-established myself as a patient (🙄), paid my $15 co-pay, and got my anxiety drugs. Now, I see him every 15 months to get my "bulk" benzo prescription.

Shit like this is one of the many reasons I will not drop my premium PPO plan for a high- deductible plan. Paying a little extra every month is worth it to not have any surprise charges. It's a $15 (PCP), $25 (specialists), or $0 (annual gyno exam) co-pay, no BS, no deductible.

[NomoreDramaQ1015]

Jun 26, 2023 12:35:43 GMT -5 Cookies Galore said:

Jun 26, 2023 7:38:48 GMT -5 NomoreDramaQ1015 said:

And if you don't you'll get a $250 new patient fee!  Every single freaking hospital here now charges one if you aren't coming in every six months.

Yet they also bitch about "wasting their time" for scheduling appointments when it isn't urgent or chronic.

Well I'd consider a completely separate appointment just to chit chat with you when we could have done it during my yearly wellness visit to be "coming in when it isn't needed".  I have no chronic issues that need followed up on.  There is absolutely no reason I need to be going to the doctor every six months.  

So which is it? 

I feel like PCP offices lost a shit load of money with the advent of urgent care and minor care clinics popping up and it backfired on t hem insisting you go there for things like a UTI or a kid's fever in the middle of the night and only go to your PCP for regular chronic issues and your wellness visit.  Now they have to find a way to recoup all that money and pay for the waterfall wall in their office waiting area. 

I've never heard of a new patient fee! I had to visit my PCP at a different location once because it had been a few years since I've seen him and "he wasn't taking new patients" at the office I've been going to my entire life. But I still got to see him, re-established myself as a patient (🙄), paid my $15 co-pay, and got my anxiety drugs. Now, I see him every 15 months to get my "bulk" benzo prescription.

Shit like this is one of the many reasons I will not drop my premium PPO plan for a high- deductible plan. Paying a little extra every month is worth it to not have any surprise charges. It's a $15 (PCP), $25 (specialists), or $0 (annual gyno exam) co-pay, no BS, no deductible.

It took me awhile to figure out what it was because physicals are supposed to be covered 100% yet I was getting a $250 bill because insurance didn't cover it.  I finally called and asked.

DH had been seeing that doctor since he was a kid but since he wasn't coming in "every six months" they consider DH to be a new patient and charge accordingly.  WTF?

They said once a year is not enough time to build a relationship with your doctor and they want to encourage people to come in more often to touch base and get issues addressed before they  become serious.  WTF?!

We avoided CHI for a while because of that.  Then Methodist and Nebraska Medicine started doing it to. 

It's not an actual part of the appointment so even when we had a PPO it didn't cover the damn fee.   It's just another way for them to milk money out of you.  Either they get you for another $175 for an office visit or a bonus $250 because you refuse to take time off and sit in a waiting room with a bunch of sick people just to say Hi to your physician.  Win win. 

Someone has to pay for all their fancy new buildings and 8 Vice Presidents.