Annual Physical Exams on Medicare

[harllee]

Medicare will not pay for a "full physical" it will only pay for an annual "Wellness Exam". If Medicare will not pay then a Medicare supplement will not pay. The rules may be different for Medicare Advantage plans. The trick is to get your physical coded as a Wellness Exam if you want Medicare to pay.

 

[travelover]

Medicare will not pay for a "full physical" it will only pay for an annual "Wellness Exam". If Medicare will not pay then a Medicare supplement will not pay. The rules may be different for Medicare Advantage plans. The trick is to get your physical coded as a Wellness Exam if you want Medicare to pay.

It is not a "wellness exam" it is a wellness VISIT. That is the crux of the difference. Mostly questions and not much hands on examination.

 

[OldShooter]

We are in a concierge program where office visits are budgeted for an hour. I get an annual physical with includes several specific blood tests. I have no idea how they code or bill it, wellness or exam or both, but they do get the Medicare payment. Probably I have a small copay but I don't remember for sure.

 

[Breedlove]

Please get an annual physical , I have been getting one since I was 40 years old and it saved my life when I had Kidney cancer . I had no symptoms .
Now what is everyone doing on the shingles shot , a friend of mine in the medical profession recommends it . I checked my part B does not pay but my part D pays partial with a deductible . The shot at Costco is 154.00 X 2

 

[harllee]

Please get an annual physical , I have been getting one since I was 40 years old and it saved my life when I had Kidney cancer . I had no symptoms .
Now what is everyone doing on the shingles shot , a friend of mine in the medical profession recommends it . I checked my part B does not pay but my part D pays partial with a deductible . The shot at Costco is 154.00 X 2

Breedlove, how did your kidney cancer show up at your annual physical? Was it through a blood test?

I definitely got the new shingles shots (both of them). I had to get on a bunch of wait lists to find the shots. I highly recommend it, it is suppose to be about 95% effective. I got shingles at age 50 (before there was a shingles shot) and it was the worst thing that ever happened to me, now 18 years later I still have pain from the shingles. My part D paid half of the shingles shot so I was out about $80 per shot, but definitely worth it if it prevents me from getting shingles again.

 

[fh2000]

Please get an annual physical , I have been getting one since I was 40 years old and it saved my life when I had Kidney cancer . I had no symptoms .
Now what is everyone doing on the shingles shot , a friend of mine in the medical profession recommends it . I checked my part B does not pay but my part D pays partial with a deductible . The shot at Costco is 154.00 X 2

There is a long thread about shingles.
http://www.early-retirement.org/forums/f38/new-shingrx-shingles-vaccine-89949.html

 

[Breedlove]

My kidney cancer showed up through blood tests . My Creatnine levels were high and my GFR was low . I had no aches or pains at all . All I can say is drink lots of water every day

 

[travelover]

We are in a concierge program where office visits are budgeted for an hour. I get an annual physical with includes several specific blood tests. I have no idea how they code or bill it, wellness or exam or both, but they do get the Medicare payment. Probably I have a small copay but I don't remember for sure.

I'm leaning in this direction. About how much do you pay for access to the concierge program above other costs?

 

[OldShooter]

I'm leaning in this direction. About how much do you pay for access to the concierge program above other costs?

Well the short answer is their fees are $3K/year for one and $5K a year for DW and me.

The longer answer, though, is that (at least in our market) the concierge offerings vary widely in what you get. I talked to one doc with a concierge practice who does not bill insurance or medicare at all. At the other extreme, the practice we use is three docs inside a large system. The design of the offerings is tricky, too, because Medicare rules try to prevent docs from upcharging patients over the Medicare rate. So you really can't generalize from one price as it's definitely apples, oranges, lima beans, and mushrooms.

More information in this thread from a couple of years ago: http://www.early-retirement.org/forums/f38/is-tomorrow-ok-to-see-the-doctor-89686.html

 

[Moemg]

I had my Medicare wellness yesterday my my Physican's PA. It was just a bunch of questions . The funny part was when she was questioning me about alcohol she kept on asking " You ever get junk" .After several times I said "Do you mean drunk " . I only drink two glasses of wine.I tried to keep from laughing . That alone was worth the visit.

 

[bmcgonig]

This wellness test seems like a waste. Why do people go?

 

[travelover]

This wellness test seems like a waste. Why do people go?

For me, it is an opportunity to ask the doc questions about issues that I am keeping an eye on. Of course, it makes me nervous as to whether I'm pushing the discussion into a situation where the visit will be recoded to an uncovered visit.

 

[aja8888]

This wellness test seems like a waste. Why do people go?

For the last 10 years now, my wellness exam include a full panel blood test, urine analysis test, PSA test and either an EKG or a bone density test. My visit and lab cost has been $0 (traditional Medicare with Full Plan F supplement).

 

[braumeister]

For the last 10 years now, my wellness exam include a full panel blood test, urine analysis test, PSA test and either an EKG or a bone density test. My visit and lab cost has been $0 (traditional Medicare with Full Plan F supplement).

I get comprehensive physicals too. Once it was denied, due to a clerical error, but they resubmitted it and all was well. I believe it's simply a matter of some physicians (or their staff) knowing how best to code things and others not.

 

[kaneohe]

For the last 10 years now, my wellness exam include a full panel blood test, urine analysis test, PSA test and either an EKG or a bone density test. My visit and lab cost has been $0 (traditional Medicare with Full Plan F supplement).

Medicare says: You usually pay nothing for Medicare-approved covered clinical diagnostic laboratory services.

Wondering if you had some symptom or pre-existing condition that was used to justify the full panel blood test. Can't see that they would do that on a routine wellness visit for everyone.

 

[DallasGuy]

Please get an annual physical , I have been getting one since I was 40 years old and it saved my life when I had Kidney cancer . I had no symptoms .
Now what is everyone doing on the shingles shot , a friend of mine in the medical profession recommends it . I checked my part B does not pay but my part D pays partial with a deductible . The shot at Costco is 154.00 X 2

I totally agree with you. About 6 years ago, I had an annual physical exam and the only thing out of the ordinary was a slightly low red blood count. My doctor told me to see a hematologist as a precaution and 1 week after that I was diagnosed with multiple myeloma (blood cancer). I had no symptoms. Because I was diagnosed early, I had no bone damage or kidney damage (common symptoms of multiple myeloma). Don't think just because you feel good that you might not be in the early stages of some type of cancer...or something else.

 

[NoMoreJob]

I been on traditional Medicare for 3 years. Every year I've had either an 'welcome to Medicare' or annual wellness exam plus other tests and physical checks that my PCP has deemed necessary. Together they have basically the same that I received prior to Medicare as an annual physical. Part of the appointment is billed as a wellness visit and part is billed separately, but all is covered by my Medicare part B plus G supplement.

I think the difficulties some are experiencing is due to doctors that either don't understand or don't want to deal with the Medicare billing/coding system. It's unfortunate because done properly it works for the patient.

 

[Katsmeow]

This wellness test seems like a waste. Why do people go?

At the prior doctor that DH had before we moved it was a practice requirement that you do it to be able to be a patient. I had the idea that there is some benefit to the practice when doctors do the wellness visits (not sure what it is) and so the practice required those on traditional Medicare to do the annual wellness visit.

 

[deserat]

I think Medicare also provides free of charge a pneumonia vaccine shot which may be worth having. Our normally very healthy daughter has recently recovered from a nasty bout of pneumonia so when I went in for my flu shot today and was offered the pneumonia vaccine I gladly accepted it.

I am recovering myself from a nasty bout of pneumonia - started as flu (which in retrospect I have never had before as I always got flu shots) and then descended into double infiltrated pneumonia - 7 days in a German hospital and 3.5 weeks discharge after still coughing a bit. Hope to never deal with this again. And would like to know who thought it was OK to be a vector for flu....sigh. Of course I will be getting a flu shot this year.

 

[Trooper]

Hi I realize this thread is a little old, but performed a search and I didn't want to start a new one given the relevance to my situation.

Every year I have trouble with the billing on the Medicare Wellness Exam. Last year I made an appointment for a Wellness Exam and when I got to the appt I spoke to both the doctor and the nurse and told them I wanted the Medicare Wellness Exam and not a physical and they said they understood. Of course I later get a bill for $300 for a full physical. I called the billing dept and complained loudly. It got fixed after 4 months and several calls and emails on my part. This year when I go for my Medicare Wellness exam I am going to tell the doctor that if I get another bill for a full physical I am switching doctors.

I wonder if that is what I need to do as well. I enrolled in Medicare for the first time this year -- Traditional with a Plan G supplement -- and received received a $335 bill for a physical. United Healthcare, my supplement provider, was of no help and told me to call Medicare.

I was very surprised since physicals have always been encouraged and free with my non-Medicare w*rk insurance. Not really sure what bumped it int the "physical" category; I have nothing wrong with me and was really going just to make sure it stays that way. I did have a routine panel of blood tests however.

For me, it is an opportunity to ask the doc questions about issues that I am keeping an eye on. Of course, it makes me nervous as to whether I'm pushing the discussion into a situation where the visit will be recoded to an uncovered visit.

For sure!

 

[grasshopper]

I didn't reread from the beginning to present.

The first visit to your GP covered under Medicare is "Welcome to Medicare preventive visit" once within the first 12 months you have Part B. visit includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services, including these:

Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
Height, weight, and blood pressure measurements.
A calculation of your body mass index.
A simple vision test.
A review of your potential risk for depression and your level of safety.
An offer to talk with you about creating advance directives.
A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.

It is hardly what a physical is called, If you ask for a physical you will get a physical and a bill to go with it. Think of it as a 20 minute chat with your doctor.

If you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam.

The medicare website has all this information, know your rights.

 

[Koolau]

I had a doctor get upset with me for asking a medical question during my MC physical. He then sat down and spent 20 minutes telling me how (at age 55) he was still paying off med school loans, he had to work 11 hours a day, he didn't make enough to cover his living in Hawaii, on and on. I was thinking, he could have saved 19 minutes and 30 seconds by just answering my questions, but what are you gonna do? The guy had to vent. He eventually became a "hospitalist" which I had to look up. I think he got more money and I'm happy for him. Glad he's no longer my doctor.

 

[audreyh1]

Somehow our PCP knows how to bill Medicare.

 

[Sarah S]

Technically with the medicare wellness the only time they would touch you is for blood pressure My pp does look in my ears and mouth listen to my heart and lungs and do a cursory abdominal exam and skin check. All that is very quick and having been on the other side I know it is because it feels so wrong not to do a physical exam. But if you bring up even a small issue (a little pain, a runny nose,whatever) that adds a medical prblem and can be billed separately.

Bloodwork though is covered without deductible as long as it is necessary and not too frequent. You can find on the web information about what some of the rules are. Cholesterol IF normal is every five years but if you have a diagnosis of hyperlipemia it is either 6 months or a year. A1 C isn’t covered unless there is a diagnosis of diabetes or hyperglycemia. Etc. it is worth looking these things up if they are tests you might have. Doctors don’t always know the exact rules and timing

 

[athena53]

I got careless and ran out of my only prescription (not mission-critical, take "as needed") and found that I couldn't get refills because it had been too long since I'd seen the doc for a wellness visit. They got me in a few days later, for which I was very grateful, and I found later it was coded as a "prescription refill visit". Cursory stuff- weight, BP, heart rate, etc. So, it's now been over a year since my "wellness exam", which I find pretty useless anyway. They used the same words in the short-term memory test 2 years on a row. If I remembered them in Year 2, could it have been because they were in long-term memory?

So- I rely on Requestatest.com 3 or 4 X/year and get the lipids panel, glucose and a1c and some general wellness blood tests. I get monitored every 6 months for breast cancer (family history), see a cardiologist for mitral valve prolapse and get colonoscopies as recommended. I suppose something could fall through the cracks but I feel pretty well-covered.

The first time I saw my primary care doc after Medicare she ordered the usual blood tests (Lipid panel, a1c). I got a bill for $800 saying Medicare had rejected almost all as "not medically necessary". I tried to get the doc's office to re-code with no results. (Diagnoses of hyperlipidemia and pre-diabetes were in my medical records.) I was saved only when the lab sent me a letter waiving it all because they'd forgotten to have me sign the Medicare Advanced Beneficiary notice. I dropped the doc after a similar coding issue later. Darn shame- I liked her.

I am VERY grateful for RequestaTest and grateful I can absorb the cost.