Medicare Wellness Billing

[calico1597]

My husband went to the doctor back in May. He's been billed for an office visit and a Medicare wellness appointment. Medicare and supplemental paid for the office visit and denied the wellness. Now we're billed $290 for the denied claim. Do we have any recourse? I have not called the the dr's billing department yet.

 

[OldShooter]

My understanding is that the wellness visit is a Medicare thing. I have never been charged for one. Maybe your visit got miscoded; check with the Dr. billing dept.

 

[SheitlQueen]

Is the doctor trying to bill for an office visit and the wellness visit both? And the visits were on the same day? Seems like it can be one or the other but not both. Sounds like double billing for one procedure. But definintely contact the doctors office to find out what is happening.

 

[pdxgal]

I think it’s possible to have both a “wellness” and “regular” visit be combined. The wellness visit doesn’t cover much. Basically if you discuss anything of substance that is associated with a diagnosis code the wellness visit then transitions to an office visit. Medicare pays for one wellness visit per year. So if it was denied, could be he’d already had one. Or maybe your Medicare plan doesn’t cover it. I know it’s part of the Medicare Advantage plans, not sure if it’s part of all supplemental plans or not. My w@rk was in the Medicare dept of an insurer, i can tell you there’s lots of member confusion and dissatisfaction around wellness va regular visits. I suggest you also contact your insurer.

 

[audreyh1]

DH did a “Welcome to Medicare” phone visit with the doctor (nurse). Our PCP requested he do it. Never saw any charges.

 

[grasshopper]

I just checked Medicare paid my doctor $345 for my last AWC in 2021,check your claims @ Medicare.gov

 

[friar1610]

Was the wellness visit literally at least 1 year + 1 day after the previous year’s? My provider is very careful about making sure they schedule them accordingly as he says Medicare is very picky about the timing.

 

[zinger1457]

I just checked Medicare paid my doctor $345 for my last AWC in 2021,check your claims @ Medicare.gov

Seems like Medicare is a lot more generous than my ACA insurance, BCBS paid my doctor $108 for each of my last two annual checkups.

 

[John Galt III]

I recently had my 2021 medicare wellness visit. I called in advance to make sure I would not be charged for it, made sure they knew I was requesting a wellness visit and nothing else. On the day of the wellness visit, I asked again about any charges, and suddenly they were all vague and clueless. I stated again I only came in for a free wellness visit, and if I get charged, I'll make sure I never come back again. Cut to the chase: The pcp office billed 3 different things to medicare, and got paid $400. A nice payment, for a half hour of asking me intrusive questions. Thankfully, I have not been billed anything.