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Old 02-18-2018, 03:11 PM   #41
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harllee, you are your own best advocate, and your only advocate in this. This billing may have happened in error. It’s also possible that office often bills the most expensive codes, and some people pay. My suggestion would be to contact the office, ask for the manager, and clearly state you specifically requested and went in for a wellness exam and that’s what they need to bill to Medicare, and if the manager refuses, discuss it directly with the physician.
Thanks, I have already talked to the billing department (very large practice, probably 50 doctors), they refused my first request to recode, I have asked to speak to a supervisor and I awaiting to hear back from that. If that does not work I will then talk to the doctor.
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Old 02-18-2018, 04:35 PM   #42
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Does anybody, personally, find these Welcome to Medicare or Annual Wellness visits worthwhile? It sounds to me like a complete waste of time, but maybe I am not understanding something.
OP here, I have certainly learned my lesson and I will never go in an annual wellness visit again! I think it would be best to go in with some complaint (like I feel sick, tired or old) and as a part of that complaint ask for things that would normally be included in the annual exam like blood work, etc. Medicare will pay if you go in with a complaint once your deductible is satisfied.
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Old 02-18-2018, 04:37 PM   #43
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OP here, I have certainly learned my lesson and I will never go in an annual wellness visit again! I think it would be best to go in with some complaint (like I feel sick, tired or old) and as a part of that complaint ask for things that would normally be included in the annual exam like blood work, etc. Medicare will pay if you go in with a complaint once your deductible is satisfied.
I think I have learned from your lesson. I doubt I will ever schedule one of these. I will be signing up for Medicare later this year.
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Old 02-18-2018, 04:42 PM   #44
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I'm not understanding how you can be billed $400 for a legitimate consultation. If you met the deductible, and assuming you have a medigap to complement your regular Medicare, other than copay depending on your medigap, how they bill that? Admit I'm new to M (almost 67) but once deductible paid we've just gotten hit with copays and some piddling little things that the state here allows them to goose you on for what M doesn't pay. For example I went in for cyst in foot, they needled it out, did ultrasound, and I don't recall all the absurd charges they sent to M, but in the end all I had was the copay for what looked like almost $1,000 charged to M. By the way, I think American healthcare "insurance" is absurd.
OP here, I am new to Medicare too (age 66) and I am trying to figure it out. Medicare will not pay anything for an annual physical (neither will the medical supplement). Medicare supposedly pays for a mythical "annual wellness exam" but as I have found out, it is almost impossible to get one. What medicare pays for is for when you go to your doctor for a sickness or problem (like your toe or the flu or something). You would think Medicare would want people to get preventative things like an annual physical to prevent disease but it does not work that way.
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Old 02-18-2018, 05:37 PM   #45
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You would think Medicare would want people to get preventative things like an annual physical to prevent disease but it does not work that way.
You might just be missing the fact that the "annual wellness visit" is just that -- a visit that covers a few administrative things. It's not an exam, and not a physical. Just a visit that shouldn't take more than 5-10 minutes total. Worthless for nearly everyone.

Even if you had been billed properly for the AWV, you would have been dissatisfied.
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Old 02-18-2018, 05:39 PM   #46
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When I have gone in for an annual exam, the office has me sign a document agreeing to pay costs not covered by Medicare. That said, I don't recall that the cost was excessive. Certainly not anywhere close to $400.
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Old 02-18-2018, 06:50 PM   #47
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OP here, I have certainly learned my lesson and I will never go in an annual wellness visit again! I think it would be best to go in with some complaint (like I feel sick, tired or old) and as a part of that complaint ask for things that would normally be included in the annual exam like blood work, etc. Medicare will pay if you go in with a complaint once your deductible is satisfied.
well, that answered my next question.

I take it then, that Medicare addresses symptom related issues. How about screening bloodwork, like the "routine" "full panel",,,often ordered at yearly physicals to screen for things like liver function, kidney function, hyperlipidemia(cholesterol et.al.), and PSA?
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Old 02-18-2018, 06:56 PM   #48
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well, that answered my next question.

I take it then, that Medicare addresses symptom related issues. How about screening bloodwork, like the "routine" "full panel",,,often ordered at yearly physicals to screen for things like liver function, kidney function, hyperlipidemia(cholesterol et.al.), and PSA?
OP here, well that is the strange thing...Medicare paid for all my blood work, full panel, cholesterol, diabetes screening, etc. (no PSA I am female but it did pay for mammogram and pap smear) but medicare did not pay for the doctor to go over the lab results with me. Also paid for pneumonia shot.
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Old 02-18-2018, 07:00 PM   #49
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You might just be missing the fact that the "annual wellness visit" is just that -- a visit that covers a few administrative things. It's not an exam, and not a physical. Just a visit that shouldn't take more than 5-10 minutes total. Worthless for nearly everyone.

Even if you had been billed properly for the AWV, you would have been dissatisfied.
OP here. But I was not informed that i would be charged for anything extra. if I had been told I could have made an informed consent. For $400 I would have thought I would have gotten much more than the 15 minutes i did. For $400 i would have expected a full exam which i definitely did not get. I guess I just need a new doctor.
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Old 02-18-2018, 08:49 PM   #50
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There must be some differences in Medicare plans. Our BC Medicare Advantage covers annual wellness visit and in addition includes an annual physical exam. You may have to pay a copay if you also are treated for a new medical condition or monitored for an existing condition at the same time you are getting your physical.
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Old 02-18-2018, 09:22 PM   #51
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I’ve read at the links provided above. Very informative, particularly the “capture billing . com”, where Manny answers some Qs at the bottom of the page. He says there is lots of confusion about this.

I had no idea that Medicare doesn’t cover a routine annual physical exam! The language Medicare uses contributes mightily to confusion for patients, physicians, coders, & billers. Medicare markets the 100% covered Annual Wellness Visit, which most literate humans would interpret as an “annual physical”. But NO, there is a nuanced difference!

My dr codes what I thought was my annual exam as “99214 - Established Patient Office Or Other Outpatient, Visit Typically 25 Minutes”. Medicare has paid 80% & my secondary has picked up the rest. This has been the case for the last 3 yrs. I looked up DH’s Medicare EOBs, ditto for him.
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Old 02-19-2018, 06:28 AM   #52
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There must be some differences in Medicare plans. Our BC Medicare Advantage covers annual wellness visit and in addition includes an annual physical exam. You may have to pay a copay if you also are treated for a new medical condition or monitored for an existing condition at the same time you are getting your physical.
Yes, Medicare Advantage plans cover more preventive services than traditional Medicare.

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My dr codes what I thought was my annual exam as “99214 - Established Patient Office Or Other Outpatient, Visit Typically 25 Minutes”. Medicare has paid 80% & my secondary has picked up the rest. This has been the case for the last 3 yrs. I looked up DH’s Medicare EOBs, ditto for him.
The provider is billing a sick person/pre-existing condition office visit. Medicare covers these.

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Most Medicare patients have chronic problems to discuss at their wellness visits. CMS allows physicians to report both the problem-oriented visit and the wellness visit on the same day, and the revenue implications of reporting both services are significant. Of course, the problem-oriented visit must be medically necessary, and both the wellness visit and the problem-oriented visit must be documented.

...Many physicians fail to bill for Medicare annual wellness visits even though code G0438 pays $64 more than code 99214.

Reference: https://www.aafp.org/fpm/2016/0500/p30.pdf
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Old 02-19-2018, 12:26 PM   #53
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Sounds to me like Harlee needs a new Dr. Somehow for last two years on MC I've been going in and getting what I'd call a physical w blood work, all I think I need. If my doc answered in inquiry about allergy and used that as justification to ding me $400 I'd be gone.

It's interesting that DW just had her annual at her Gyn, approved for mammo and bone density as well as colonoscopy. Should be good to go, right? Nope. MC won't allow the Gyn to take bloodwork so he sends her to her rarely seen GP for that. Nuts I tell ya.
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Old 02-19-2018, 01:01 PM   #54
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Sounds to me like Harlee needs a new Dr. Somehow for last two years on MC I've been going in and getting what I'd call a physical w blood work, all I think I need. If my doc answered in inquiry about allergy and used that as justification to ding me $400 I'd be gone.

It's interesting that DW just had her annual at her Gyn, approved for mammo and bone density as well as colonoscopy. Should be good to go, right? Nope. MC won't allow the Gyn to take bloodwork so he sends her to her rarely seen GP for that. Nuts I tell ya.
Would one typically wait for some sort of authorization from MC before having the bloodwork done? How did you find out that MC wouldn't allow the GYN to take the bloodwork?
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Old 02-20-2018, 10:54 AM   #55
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Would one typically wait for some sort of authorization from MC before having the bloodwork done? How did you find out that MC wouldn't allow the GYN to take the bloodwork?
No authorization would ever be given in this situation: the GYN specialty has no need to review bloodwork. This may not be Medicare - but the state laws that govern medical professionals.
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Old 02-20-2018, 11:54 AM   #56
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No authorization would ever be given in this situation: the GYN specialty has no need to review bloodwork. This may not be Medicare - but the state laws that govern medical professionals.
I do have some blood work done at my GYN--to check for hormone levels, etc.
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Old 02-20-2018, 09:13 PM   #57
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Several things:

1. It is astonishing to me that some people seem to be looking for a way to criticize the OP for what is clearly the fault of either the physician or the billing department. She was clear that she wanted an annual wellness visit. She knew what it was and didn't ask for anything else. Even if the physician did ask about her allergies (which is not clear), at most the physician seemingly would have been able to bill for that problem -- it wouldn't have converted the visit to a physical. If the billing office won't correct it, if I was her I would consult with the physician to try to get it cleared up. If that didn't work I would send a strong letter and would switch physicians.

2. I don't think the annual wellness visit is all that valuable. Note that some practices require patients to have one. DH is on Medicare (I'm not yet) and our doctor has a written statement on their website that patients must do the annual wellness visit to stay part of the practice. This is because Medicare is wanting physicians to do them in order to get full reimbursement for Medicare services. The statement is clear that the wellness visit is not a physical and is clear about what is and is not included. FWIW, DH went in and did the visit with the nurse practitioner and it was properly billed as such.

3. About the lab tests run and that were covered. First, Medicare does cover some preventative services. They just don't cover a generic physical. So, a mammogram would be covered annually for example. There are lists of the preventative services covered and how often.

Routine blood work isn't covered if it is just for preventative purposes. I did a physical a few months ago and routine blood work was done. All of this was covered as I am not on Medicare. But, routine blood work wouldn't be covered on traditional Medicare if it was just done routinely as a preventative service. That said - it is covered if it is to diagnose or monitor something. So, for example, I have low Vitamin D. So if I was on Medicare I am sure my Vitamin D testing would be covered since I have that history. I would guess cholesterol testing would be covered for most people on Medicare because many would either have high cholesterol already or due to age would be at risk. The point being that blood work doesn't have a particularly high bar it is has to meet to be considered to be to diagnose or monitor something.
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Old 02-21-2018, 06:59 AM   #58
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OP here, I am starting to look around for another doctor in my town to move to. So far I have been unable to find any doctors in other practices in my town that accept Medicare and are taking new patients. The practice I am with seems to have most the doctors in town that take Medicare. I am surprised at how many doctors do not take Medicare at all.

Any suggestions how to find a doctor that takes Medicare and is accepting new patients?
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Old 02-21-2018, 08:37 AM   #59
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It's not easy.
I asked the same question recently here.
http://www.early-retirement.org/foru...tor-90477.html
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Old 02-21-2018, 08:49 AM   #60
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Any suggestions how to find a doctor that takes Medicare and is accepting new patients?
My Medigap provider (Blue Cross/Blue Shield) has a website that assists their insured in finding a doc in their area. You might check to see if your Medigap provider does the same.
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