Annual Physical Exams on Medicare

[aja8888]

As "well" as you are, are you certain your billing isn't due to your yearly deductible? I always get hit with that, first of the year. Perhaps this is the first (or second/third) time you've had a bill - and you're up-front deductible is just now coming due. It's a SWAG on my part, so YMMV.

No, I covered my $226 deductible earlier this year when I had Covid. And this was not approved so it's not subject to the deductible.

 

[aja8888]

Blood work is not subject to deductible on regular medicare. It sounds like a coding issue. Without knowing what was ordered can’t say but medicare only covers a screening cholesterol every five years. With a hypercholesterolemia diagnosis or similar it would be covered more often. This is an example but there are other similar restrictions. Medicare covers most blood tests with a relevant diagnosis though there are limits on frequency for some things even then

Lipid, urine, metabolic panels. No PSA or other stuff.

 

[folivier]

I've found blood tests on Medicare to be hit or miss. DW and I see the same LNP at the same time and for whatever reason she has trouble with MC paying her lab bill sometimes. Mine is usually ok. She's checked and will make certain the office knows about our lab bills. But it still doesn't always work.

 

[bmcgonig]

Lipid, urine, metabolic panels. No PSA or other stuff.

If you have a diagnosis of high cholesterol then the lipid is covered, otherwise probably not except as mentioned above, every 5 years.

ETA

This co will do the lipid panel for around $25

https://www.ultalabtests.com/testing/search

 

[aja8888]

If you have a diagnosis of high cholesterol then the lipid is covered, otherwise probably not except as mentioned above, every 5 years.

ETA

This co will do the lipid panel for around $25

https://www.ultalabtests.com/testing/search

I don't have high cholesterol or any other known issue that would require blood tests. Previously, my blood tests were covered, but this time...not.

Thanks for the link!

 

[JoeWras]

I'm not on MC yet, but I monitor this thread because I'm close.

My long time PCP always puts three diagnosis on my card, for better or worse. I had all three conditions from time to time over the years. Nevertheless, he puts it on there. This makes the magic occur with insurance. Is it unethical? Not really, since they pop up time to time.

The "back pain" one is a pain though, because sometimes the insurance comes knocking asking if I was in an accident so they could push the bill on someone else. Just more paperwork to do.

It is a good thing I'm not looking for any kind of insurance though. His persistent habit of doing this would likely sink me for various forms of insurance, or maybe even something like a pilot's license, which I am not pursuing.

 

[CardsFan]

The staff at my PCP office seem to be really on the ball, compared to some of the experiences here.

Pre-Medicare, they always asked if I had met my deductible before sending me for testing (x-ray, Ultrasound type things). If I had not, they made sure to send me to a low cost provider. If I had, they just asked what would be most convenient.

Now on Medicare, they seem to know how to code everything properly. With a history of HBP and high cholesterol, they always order the proper blood tests for those, usually annually. I go twice a year, about 6 months apart. One is the annual Wellness check, and one is to confirm my prescriptions.

 

[Breedlove]

I had the annual test along with a blood test , got a bill for 220.00 from Quest . I called them up and explained that the lady at Quest who took all my information said I would not have to pay anything . All would be paid by Medicare . She took my Medicare Info and said the lady at the Quest office only gave them the supplemental insurance and they declined ..I think this is a Quest gimmick .

 

[Koolau]

The staff at my PCP office seem to be really on the ball, compared to some of the experiences here.

I would add that my health-care netw*rk (aka Queens) seems to get the insurance right about 99%(+) of the time. I hate insurance hassles and give thanks that Queens network seems to have competent staff for insurance filing.

 

[Car-Guy]

I had my annual wellness exam at the same place I have been going to for 7 years, but this time, the Doc I had been seeing had moved on. So I got a new Doc and we did the exam, if that's what we call it.

+1 No joke.... I brought a copy of my bloodwork that I had done about a month earlier from another doctor (specialist) and my PCP accepted that. IIRC he took my weight and BP and we talked for 5 minutes and then he asked, what do to need today? I said just prescription refills. Okay, done. Have a good day.

 

[Koolau]

+1 No joke.... I brought a copy of my bloodwork that I had done about a month earlier from another doctor (specialist) and my PCP accepted that. IIRC he took my weight and BP and we talked for 5 minutes and then he asked, what do to need today? I said just prescription refills. Okay, done. Have a good day.

Sounds like you got the "luxury" version.

Seriously, my doc does go over the blood w*rk with me as I always have a few items out of spec. He assures me that "this" result doesn't mean anything right now - "we'll watch it."

One item he's following is a possible suggestion of future cancer - same one my little sister had - so he's watching it very closely - and even ordered another test a couple of years back. That factor is now back to normal.

The "exam" is very cursory as you suggest, but the doc can make the whole process very meaningful if he is that kind of doc - thankfully my doc is very thorough. YMMV

 

[youbet]

Yep, a Medicare "Wellness Check" is NOT a physical and doesn't claim to be.

From the 2024 "Medicare and You" booklet.

Medicare covers medically necessary clinical diagnostic laboratory tests when your doctor or provider orders them. These tests may include certain blood tests, urinalysis, certain tests on tissue specimens, and some screening tests.

Unfortunately, I have plenty of issues that my PCP follows via blood work, so my lab work goes in as checking the progress of existing conditions which is covered. Also my doc orders these tests over the year and not at the time of the "Wellness check."

 

[Katsmeow]

In the few years I have been on Medicare I usually had lab work done every year by my PCP. I would go in for some reason or other and if it had been a year or close to it, he did the lab work. I do have high cholesterol so they could do that more often than for people who don't.

We recently moved and I signed up with an MDVIP concierge practice. The concierge fee is $1800 a year. We mostly signed up to have the availability of a doctor on quick notice and to have unhurried visits. (So far, things are going well on that front).

They do sell themselves on their annual physical however. I am supposed to do it in December and they run an extensive battery of tests, far more than I got from annual physicals pre-Medicare. Then there is a 2 hour visit with the doctor to discuss. We'll see if all of that gives any value. (I am sure it will give some just not sure how much).

Of course, I am fully aware that Medicare won't pay for this physical but it is included as part of the concierge fee.

 

[Koolau]

In the few years I have been on Medicare I usually had lab work done every year by my PCP. I would go in for some reason or other and if it had been a year or close to it, he did the lab work. I do have high cholesterol so they could do that more often than for people who don't.

We recently moved and I signed up with an MDVIP concierge practice. The concierge fee is $1800 a year. We mostly signed up to have the availability of a doctor on quick notice and to have unhurried visits. (So far, things are going well on that front).

They do sell themselves on their annual physical however. I am supposed to do it in December and they run an extensive battery of tests, far more than I got from annual physicals pre-Medicare. Then there is a 2 hour visit with the doctor to discuss. We'll see if all of that gives any value. (I am sure it will give some just not sure how much).

Of course, I am fully aware that Medicare won't pay for this physical but it is included as part of the concierge fee.

When we speak of a "physical" I assume that one must undress to be thoroughly examined. The only time I've been asked to undress of late was when there was a complaint on my part that required undressing to check the complaint. Therefore, I consider that it's been perhaps 35 or 40 years since I've had what I would call a physical. I realize it's semantics. I'm guessing some docs are doing what they call "physicals" via tele-health.

When I went for my 3rd class Airman's physical, it was pretty much like in the physical described in "Alice's Restaurant" (draft physical - which I also underwent with about a hundred other naked guys.) "They was leavin' no part untouched" in Arlo Guthrie's words.

So when my doc has me sit on the exam table and discusses my test results - maybe listens to my heart THROUGH my shirt, I don't consider that a physical - but YMMV.

 

[Katsmeow]

So when my doc has me sit on the exam table and discusses my test results - maybe listens to my heart THROUGH my shirt, I don't consider that a physical - but YMMV.

I have never in my life had a doctor have me completely undress. Well, I guess the gynecologist sort of has but they don't examine the whole body.

I will say that I am not sure now that they really do have to have us undress to gain information. A skin check I guess would involve that although limited.

 

[Koolau]

I have never in my life had a doctor have me completely undress. Well, I guess the gynecologist sort of has but they don't examine the whole body.

I will say that I am not sure now that they really do have to have us undress to gain information. A skin check I guess would involve that although limited.

Ahhh, yes. The dermatologist.

Well, that's ONE exam where she looks at (almost) every square inch. She instructs me to leave on my tidy-whiteys. Now, a doctor friend of mine in the Islands says that they should look at EVERY single square inch - even the okole (Hawaiian for "where the sun don't shine") BECAUSE she points out: melanoma often presents itself in places that sun rays don't usually reach. Heh, heh, they never reach mine! I don't look good in a thong bathing suit - not that I've ever actually worn one.

It's true that doctors rarely have you strip nude, but in the past, there was usually at least an incident of "drop trau" and certainly "take off your shirt." But I especially recall as a young man, every "physical" included the "turn your head and cough" routine (or, in Arlo Guthrie's case - "Alice's Restaurant" - it was "turn your hat and cough.") If you haven't seen the movie, it's worth a look just for the draft physical scenes (and then, you will understand the occasional obscure reference to "The Group W bench.") But I digress.

Up until relatively recently - when the guidelines apparently changed - there was the dreaded DRE. Of course, that was also an opportunity for an occult blood test which has saved many lives. But, apparently, the DRE led to too many false positives. I wonder if it just takes too much time. to have patients in and out of clothes during an exam. If I were a PCP, I would at least ask patients if they wanted a cursory exam for suspicious skin lesions. IF I found anything like that, I'd insist they visit a dermatologist.

What I want from a PCP or other doc is a thorough exam that gives me the best chance of living a longer, healthier life. I don't suppose anyone really likes being "looked" at clinically but it can save your life, done properly. My PCP (who actually seems better than most - at least he spends a good amount of time with me) never checked my neck for swollen glands (or whatever) and I eventually had a lung biopsy which showed I had stage 4 thyroid cancer. A simple neck exam might have caught that earlier. By the time my thyroid was removed, I could feel the swelling and changes suggesting something was wrong.

Spending health care dollars wisely is a delicate game. Catching the "easy" stuff with blood tests is probably the most cost-effective approach. But, just "looking and touching" doesn't cost much and could easily turn up something a blood test missed.

End of what ever this is - a rant? I don't think so, but it's okay if anyone else thinks so. Returning you now...

 

[JoeWras]

Up until relatively recently - when the guidelines apparently changed - there was the dreaded DRE. Of course, that was also an opportunity for an occult blood test which has saved many lives. But, apparently, the DRE led to too many false positives. I wonder if it just takes too much time. to have patients in and out of clothes during an exam. If I were a PCP, I would at least ask patients if they wanted a cursory exam for suspicious skin lesions. IF I found anything like that, I'd insist they visit a dermatologist.

Wait, wait, wait. New guidelines? My 70-something year old PCP loves the DRE. No change from him. He usually rolls with the changes so I'm surprised.

There's no worse feeling in the world that watching him open that drawer and get out a tube of something and put on his gloves. First step is to drop trau and have me cough while grabbing and pressing in undesired areas. I can handle that, Dad had 3 hernias, one almost fatal. But the DRE? BLAH!

He gave me one PSA test in my 40s when I started more frequent nighttime urination. Now that I'm 60, I should probably ask for another baseline PSA, no?

As for skin, my dermatologist is a lady too and she doesn't make me drop jockey trau. Perhaps that is a mistake. My good friend died from melanoma and his first symptom was a lump under the jockeys. They never found the source, it could have been in his toenail bed. Or it could have been the groin.

I'll just say stage 4 melanoma is a horrible, horrible thing.

 

[Midpack]

I get a physical once a year, basically a wellness check plus bloodwork once a year in Jan, plus follow up if I’m having any issues at time of physical - including additional tests. My PCP must know how to code everything because I’ve never paid anything but my deductible, Medicare or my plan G covers it all.

While my physical doesn’t include undressing, my dermatologist checks me out every 6-12 months in Feb because I’ve had a couple basal cell carcinomas over the years. Those visits don’t cost me anything either.

So I’m getting a pretty complete physical at least once a year without paying anything.

Also DW and I pay nothing for dental exams every 6 months, including annual x-rays, separate policy.

 

[Koolau]

He gave me one PSA test in my 40s when I started more frequent nighttime urination. Now that I'm 60, I should probably ask for another baseline PSA, no?

I think the PSA as a pure diagnostic (no symptoms or previous diagnostic) is on the way out. Some docs (mine included) think it's too apt to lead to false positives. This is especially true for older guys like me. More likely to die WITH PC than FROM PC. So, we had "the talk" a couple of years back.

 

[Ronstar]

I get the wellness check and bloodwork once a year. Digital prostate exam plus PSA yearly. Had baseline EKG first Medicare exam that led to nuclear stress test for further testing. All paid by medicare and supplemental insurance.

Skin check at dermatologist yearly. (Today) Also covered by medicare.

 

[Dawg52]

I go in every year for blood work that is normally done in a physical and get a flu shot at that time. And I can ask any health questions. All is paid for by Medicare. I don't know how they code it or what they call it. I don't do the Medicare wellness exam.