Annual Physical Exams on Medicare

[fh2000]

I have been going to my PCP for 20 years. He is about the same age as I. Last year, it was the first time instead of an annual physical, I scheduled my first 'Wellness Check' with him.

As far as I can tell, he does exactly the same routines with me like it is a physical. He answer all my questions without hesitation, then ask me to undress. He then listen to my lung, check my whole body skin, press my abdomen for any pain, check my feet for any swelling, etc.

Then the office helper comes in to draw my flood. A week later, his office sent my a letter with all the numbers and his recommendations. Medicare paid all his service. Mine is $0.

This year, I have also scheduled a 'Wellness Check' for later this year. His office said to call again a month ahead, so he can write up a blood test order beforehand. So, he can review my blood results in our Wellness check session together.

He is a good doctor. Their small practice was bought out by a larger health group, and I already experienced some bureaucracy. I hope he will not be fored by new policy and limit his services.

 

[Koolau]

Somehow our PCP knows how to bill Medicare.

Nope, it's the nice ladies in the office that know that! I've had to ask them questions about billing and they'll whisper that the doctor doesn't keep up on such things. It's THEIR j*b! This has especially come up when the doc wants a test and medicare denies it at the lab - optional to pay for it on your own. Usually because you've had that test too recently - either by your ordering doc or by another of your docs who ordered it "too recently" to be covered. There are ways around that - and the nice ladies can handle that as well. You want to get to know the nice ladies in the office.

 

[Koolau]

He answer all my questions without hesitation, then ask me to undress.

He is a good doctor.

My doc has NEVER asked me to undress for any reason. I kinda wonder what kind of doc never wants to "take a look under the hood." He even told me once that he no longer does the DRE test because, like the PSA test, it leads to a lot false positives and a lot of tests which may be more invasive and even dangerous - risk vs benefit. Of course, with the right symptoms, that could all change (age is a big factor as well.)

At the "wellness" exam, he doesn't even have me take off my shirt to listen to my heart/lungs. What's up with that?

Having said all that, my doc (PCP) has really steered me in the right direction on several issues. I'm grateful to him (he may actually be credited with saving my life - but that's always a debatable subject.) Anyway, I trust him, but I've concluded that MOST docs these days simply don't have (or take) the time for a truly thorough exam. YMMV

 

[Dash man]

My Medicare Annual Wellness checks aren’t much different than the pre Medicare physical exams I had. I have enough going on to justify all the bloodwork. I see my PCP, cardiologist and nephrologist twice a year and my dermatologist annually. I only have to get undressed for my dermatologist (skin check) and a shirt off for EKGs or stress tests. They listen to my heart and lungs through my shirts.
I’m very happy with my set of doctors, and they’re all younger than me, so I hope I won’t have to change.

 

[foxfirev5]

My Medicare Annual Wellness checks aren’t much different than the pre Medicare physical exams I had. I have enough going on to justify all the bloodwork. I see my PCP, cardiologist and nephrologist twice a year and my dermatologist annually. I only have to get undressed for my dermatologist (skin check) and a shirt off for EKGs or stress tests. They listen to my heart and lungs through my shirts.
I’m very happy with my set of doctors, and they’re all younger than me, so I hope I won’t have to change.

Yeah, after years of trying to avoid any preexisting conditions, I find them helpful with Medicare. With high cholesterol, a little overweight, history of prediabetes, right bundle blockage, and cancer I can get about any test covered. My annual wellness visit is just a jumping off point for the rest of the stuff. Medigap plan G keeps it pretty simple from a billing perspective. Pay the annual deductible and rest sorts itself out.

 

[pacergal]

One reason I enjoy our Kaiser Advantage--very good billing system.
Almost every visit is no charge. DH and I have both received refunds in the past year for a few visits we were charged for upfront, which apparently were billed as preventative at the end.

 

[Koolau]

My Medicare Annual Wellness checks aren’t much different than the pre Medicare physical exams I had. I have enough going on to justify all the bloodwork. I see my PCP, cardiologist and nephrologist twice a year and my dermatologist annually. I only have to get undressed for my dermatologist (skin check) and a shirt off for EKGs or stress tests. They listen to my heart and lungs through my shirts.
I’m very happy with my set of doctors, and they’re all younger than me, so I hope I won’t have to change.

Oh, yeah, the dermatologist: Do have to undress there for sure. DW and I always go together to save a trip. We even do the underwear thing together. Surprised our doc doesn't insist we do the Full Monte as I've heard of melanoma even where there is no sun exposure - if you know what I mean. This last time, DW did have a cancer - but right on her lovely face (healing up very nicely, thank you.) YMMV

 

[YakGrl]

Thank you for this thread info. I will be going on Medicare late next year and will be proactive on making appointments for all screenings and test results needed prior to switching over to medicare.

 

[bmcgonig]

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.

Same issue here, except that I was lucky in that the phlebotomist at Quest was able to tell me that Medicare would not cover my cholesterol tests. Somehow that data was available on her computer. She then asked me if I would like to pay. I declined, knowing I can order the tests myself much cheaper.

I did my last Medicare wellness as a video visit knowing that it was quite useless after the first one I did. It does serve as a way to renew any prescriptions.

Just FYI, you might find Ultalabtests much cheaper for ordering blood test. At least I have.

 

[Breedlove]

I didn’t know that the cholesterol blood test wasn’t covered . I have Medicare and part G and yesterday I got a bill from Quest and thought it was a scam and deleted it .

 

[grasshopper]

I didn’t know that the cholesterol blood test wasn’t covered . I have Medicare and part G and yesterday I got a bill from Quest and thought it was a scam and deleted it .

If you were diagnosed with hyperlipidemia (high cholesterol) Medicare can cover it. I haven't had high cholesterol for 10 years, but my GP orders a lipid panel, every year paid by Medicare.

Like someone said before the more pass illnesses you have the better chance that Medicare will cover your blood tests.

 

[Happyras]

I took my DW in for her annual Wellness Visit yesterday. We are on Medicare with a HD plan G. It was posted in many places that billing for wellness visits with other issues discussed would be billed separately. Actually, when our doc came in he explained that he could not discuss anything if it were a Wellness Visit, as he could not bill Medicare for both on the same day. After going round the topic, we caved in and cancelled the Wellness Visit and made it a normal office visit so he could update her prescriptions and bill for that.

I asked if the Wellness Visit was required, he said no but Medicare will likely contact you to encourage you to do so. Now he did say that if we had a Part C Advantage Plan, he could do both and bill for an extra office visit, but with the Medigap plan or Medicare B alone he could not. The Wellness Visit is really a joke anyway. The nurse came in early and did the questions before the doc. She did the memory test, short term my wife was OK, but after a few minutes she could not remember all three words.........not so good.

Also, he did say if we did the Wellness Visit, anything else would have to be paid up front in cash since he could not bill Medicare for it. I find this really offensive, not the doc, but how Medicare limits your ability to get proper care.

 

[Sarah S]

I took my DW in for her annual Wellness Visit yesterday. We are on Medicare with a HD plan G. It was posted in many places that billing for wellness visits with other issues discussed would be billed separately. Actually, when our doc came in he explained that he could not discuss anything if it were a Wellness Visit, as he could not bill Medicare for both on the same day. After going round the topic, we caved in and cancelled the Wellness Visit and made it a normal office visit so he could update her prescriptions and bill for that.



Also, he did say if we did the Wellness Visit, anything else would have to be paid up front in cash since he could not bill Medicare for it. I find this really offensive, not the doc, but how Medicare limits your ability to get proper care.

I believe that to be untrue. I have been fired 10 years now but we certainly used to bill both. And I found this https://www.acponline.org/practice-...ysician,during a single beneficiary encounter.

I also saw something on the cms site that said one could bill both a wellness visit and other medically necessary service for the same date

 

[Happyras]

I believe that to be untrue. I have been fired 10 years now but we certainly used to bill both. And I found this https://www.acponline.org/practice-...ysician,during a single beneficiary encounter.

I also saw something on the cms site that said one could bill both a wellness visit and other medically necessary service for the same date

I would guess their accounting company is confusing the issue with improper coding, so they just gave up trying to bill Medicare. It could be a practice issue, but in any case our doctors office will not.

 

[Koolau]

Same issue here, except that I was lucky in that the phlebotomist at Quest was able to tell me that Medicare would not cover my cholesterol tests. Somehow that data was available on her computer. She then asked me if I would like to pay. I declined, knowing I can order the tests myself much cheaper.

I did my last Medicare wellness as a video visit knowing that it was quite useless after the first one I did. It does serve as a way to renew any prescriptions.

Just FYI, you might find Ultalabtests much cheaper for ordering blood test. At least I have.

I have always received an official form from the lab notifying me that a test will not be covered along with a place to sign that I know this fact. The cost of the test is also included on the form in case I want to go ahead with the test.

 

[harllee]

I took my DW in for her annual Wellness Visit yesterday. We are on Medicare with a HD plan G. It was posted in many places that billing for wellness visits with other issues discussed would be billed separately. Actually, when our doc came in he explained that he could not discuss anything if it were a Wellness Visit, as he could not bill Medicare for both on the same day. After going round the topic, we caved in and cancelled the Wellness Visit and made it a normal office visit so he could update her prescriptions and bill for that.

I asked if the Wellness Visit was required, he said no but Medicare will likely contact you to encourage you to do so. Now he did say that if we had a Part C Advantage Plan, he could do both and bill for an extra office visit, but with the Medigap plan or Medicare B alone he could not. The Wellness Visit is really a joke anyway. The nurse came in early and did the questions before the doc. She did the memory test, short term my wife was OK, but after a few minutes she could not remember all three words.........not so good.

Also, he did say if we did the Wellness Visit, anything else would have to be paid up front in cash since he could not bill Medicare for it. I find this really offensive, not the doc, but how Medicare limits your ability to get proper care.

When I was going to a family practitioner I use to get this kind of run around about the wellness visit. Now I go to a gerontologist and get an annual check up that is somehow paid by Medicare, the gerontologist's office knows how to do it.

Regarding your wife not being able to remember the 3 words, that is concerning, maybe she needs a more complete cognitive work up. I just moved into a continuing care retirement community and I had to take a fairly detailed cognitive test in order to get admitted. I was give 5 words I had to remember for 20 minutes and both DH and I were able to remember all 5 words. I have been told that about 30% of applicants do not pass the cognitive test and are denied admission.

 

[Katsmeow]

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.

I do think paying for your own tests like this is the way to go. A couple of years ago my doctor did a panel of tests which included A1C (I didn't know in advance what tests would be done). Doctors office asked me to sign the Advance Notice in case Medicare didn't pay which apparently one lab they use required. I refused to sign it saying I only wanted what Medicare would pay (I might consider other things but would want to talk to the doctor later). So, they switched my lab work to Lab Corp which didn't require the notice. Later on, Medicare did not pay for the A1C but I didn't have to pay. However, last year my doctor again ordered an A1C (I didn't sign anything) and Medicare paid it with no comment.

For the lipid panel I have had high cholesterol for years and last year started a statin. This past year I went through a lot of medication changes to see what statin dosage I need. I had a lipid panel last August, then one in Dec, March and June. I am about to have another. During all this I had a lot of cardiac tests and an angiogram so have a heart disease diagnosis now. If they give any issue about paying for the panel I will just get one on my own.

 

[Trooper]

So how is someone on traditional Medicare supposed to get annual blood work that might predict a future problem, especially a person with no pre-existing conditions? Is the expectation that we do nothing until it's too late?

For those recommending paying for outside lab work, what steps are taken once results are received? Are the results already interpreted as part of the service? Or does one need to see a physician anyway for interpretation and possible treatment?

Not liking this part of traditional Medicare.

 

[OldShooter]

So how is someone on traditional Medicare supposed to get annual blood work that might predict a future problem, especially a person with no pre-existing conditions? Is the expectation that we do nothing until it's too late? ...

Well, there is a lot of stealthy health care rationing. Like it or not, the country cannot afford all of the health care that people would like to have. Said in economist terms, when a resource is mispriced it gets misused. Free medical care is not really free, it is simply mispriced.

Take the PSA test for example. The stats tell the health care managers that widespread PSA testing yields a lot of false positives with consequent high cost but unnecessary treatments. So the cost-effective decision is to minimize the testing and let the chips fall where they may for people who actually have prostate cancer.

 

[Gotadimple]

So how is someone on traditional Medicare supposed to get annual blood work that might predict a future problem, especially a person with no pre-existing conditions? Is the expectation that we do nothing until it's too late?

As you are researching, I recommend you visit Medicare.gov and look at the Medicare handbook which shows all procedures covered by traditional Medicare.

Back before Medicare Advantage and Medicare Supplement there was only Traditional Medicare Part A and Part B. If you were examined by your doctor and they determined you needed bloodwork, you went to their lab, and they billed Medicare and you: 80% of the cost billed to Medicare, 20% of the cost paid by You.

But your doctor won't order lab work unless there are other symptoms suggesting a lab test will help determine the cause of symptoms and ultimate treatment.

 

[athena53]

So how is someone on traditional Medicare supposed to get annual blood work that might predict a future problem, especially a person with no pre-existing conditions? Is the expectation that we do nothing until it's too late?

Well, that's the problem. I knew I had high fasting glucose (>100) and high cholesterol from exams I got pre-Medicare. I learned from the people here that a1c was a better measure of diabetic tendencies than fasting glucose. So, I monitor them all a few times a year. My a1c was once at 6.0 and last time it was at 5.3.

For those recommending paying for outside lab work, what steps are taken once results are received? Are the results already interpreted as part of the service? Or does one need to see a physician anyway for interpretation and possible treatment?

Not liking this part of traditional Medicare.

They always flag values that are out of normal range when you see your test results. No docs involved but I supply results to my PCP and my cardiologist for their records. It's pretty easy to do your own research with Dr. Google and then discuss anything that concerns you with your doctor. Sometimes it helps to see trends, too. One doc noted my somewhat low white blood cell count. I could tell her it's been that way for years and I probably get sick less often than average. Sometimes your "normal" is different.

 

[teej1985]

Physicians Mutual Medigap evidently has a rider that includes physicals:

Add Preventive Benefits Plus Rider (F019) for $9.53/month:

Routine physical exams
Health screenings
Routine blood work
Silver&Fit® exercise and healthy aging program.

 

[aja8888]

Paying for bllodwork

Healthy guy here...no known issues.

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.

I had bloodwork done, like always, only this time I got a $180.00 bill from the lab. Medicare did not cover it as they did in the past. And I can't get the Doc to try to have it re-coded and resubmitted. Giant PIA!

I think I'm going to go the route of paying up front for my blood tests and submitting them to the Doc. Or maybe I should get a new Doc.

I have traditional Medicare and Sup Plan G.

 

[Koolau]

Healthy guy here...no known issues.

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.

I had bloodwork done, like always, only this time I got a $180.00 bill from the lab. Medicare did not cover it as they did in the past. And I can't get the Doc to try to have it re-coded and resubmitted. Giant PIA!

I think I'm going to go the route of paying up front for my blood tests and submitting them to the Doc. Or maybe I should get a new Doc.

I have traditional Medicare and Sup Plan G.

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.

 

[Sarah S]

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