Medicare Wellness Scam

[becca]

Since turning 65 and going on Medicare, my annual physicals have become Medicare Wellness Checks. In my opinion these are totally worthless. It basically consists of the doctor asking a few questions to make sure your mind still works, taking my bp (which i do occasionally at home), height/weight (also do at home) and listening to my heart. My doctor will only order blood work for me every 5 years because I have no health problems (not complaining about being healthy).

It's basically the same for DH although they do annual blood work on him because he has high BP.

For both of us, when the bill for these visits come, there is the $200+ charge for the Medicare wellness exam and ALWAYS an extra office visit charge. When questioning the extra office visit charge I was told if you bring up any issue or question with your doctor they count it as a separate office visit. My husband and I go to different doctors and they are both doing this. I assume it's the doctors way to get more money out of the Wellness checks. So my husband and I both ended up paying $129 each for our supposedly covered annual medicare check.

There really is nothing my doctor did at this visit that I could not monitor myself and since I am on no medications, I am going to forego this Wellness check until I'm at my 5 year mark and can get the blood work done. Of course I will go to the doctor if a health issue arises.

 

[athena53]

Yeah, I don't need mine for much except that I'm on one prescription that needs to be renewed annually. I get my own bloodwork through requestatest.com since there are some components I want to keep under control (and it will flag anything else that goes out of bounds). I donate blood regularly so I know my BP and I have a FitBit that tells me what my heart is doing! I have a cardiologist to monitor one issue and have a relationship with a local breast health center for regular testing because I'm high-risk due to family history, but those are independent of my PCP.

I suppose I'll get billed for a brief discussion on the cardiac issue when I see my PCP next month so I'll end up with the extra charge but I don't begrudge them that. Most docs these days have hectic schedules, big student loans and high malpractice premiums and aren't driving around in BMWs.

 

[sengsational]

Having a trained eye look you over might uncover something earlier, especially if they palpate, ask questions, and are attuned to things that might spell trouble. But I agree that they think it's "convenient" for the patient to go over existing conditions. They're driven by their bosses to do it for the revenue, I expect. You can try this: When the doc walks in, you say, "I will make another appointment for condition A, condition B and condition C (all the stuff they have in your chart). I expect this visit to be a true well visit". Then, if they bill you beyond the well visit, you can use that statement to push back.

 

[Aerides]

I wouldn't go to a PCP who would not order annual bloodwork. If I felt compelled to stay with them for some other reason, I'd order a full slate of tests myself and pay directly.

5 years is far too long to go between blood tests at 50, let alone at 65. Borderline malpractice IMO.

 

[braumeister]

I've had two different primary doctors since going on Medicare, and both have always given me a full physical including blood work. They bill for it, and my supplement pays whatever Plan B doesn't pay, so there is no difference for me from before going on Medicare.

I think the problem here might be just a case of doctors either not knowing or not caring how to properly code things, so they do the minimum required.

 

[athena53]

I've had two different primary doctors since going on Medicare, and both have always given me a full physical including blood work. They bill for it, and my supplement pays whatever Plan B doesn't pay, so there is no difference for me from before going on Medicare.

I think the problem here might be just a case of doctors either not knowing or not caring how to properly code things, so they do the minimum required.

Yes. I nearly got burned on this. Doc's office didn't code the tests correctly (my a1c and LDL are borderline high so need to be monitored) and the lab first said I owed $800 because Medicare said the tests were not medically necessary, and then said "never mind" because they hadn't had me fill out the appropriate waiver form. Phew! I really liked my doctor but switched to another one whose staff knows how to code procedures correctly.

 

[harllee]

I moved from a regular GP who billed me for my annual Medicare exam to a geriatric doctor. The geriatric doctor knows how to bill Medicare and gets everything paid. I get a full exam every year and blood work and I am not billed for anything except my deductible. If your GP does not know how to correctly bill Medicare change to a doctor like a geriatric doctor who knows the Medicare rules. I also like that the geriatric doctor knows more about my ailments like arthritis, etc and does not make dumb statements about how I should expect more aches and pains because I am getting older.

 

[Helen]

I turn 65 this year. I'm on Federal BCBS and am trying to decide whether to enroll in Medicare part B or just pick up part A only. I've been on Federal BCBS for 25 years and have been happy with it. Roth conversions or RMDs will cause IRMMA to increase my part B premium.

Are there other drawbacks to Medicare, similar the one listed in the OP?

 

[W2R]

Goodness! If my doctor was like the OP's doctor I'd be quite annoyed. I am 73 and have not paid a penny to my doctor since I went on Medicare at age 65. I think my federal employee/retiree BCBS Standard pays him. I don't think I have had one of those Medicare "Wellness checks" so far.

I see my doctor every 6 months, or every 3 months if he is not happy with my blood sugar (I have type 2 diabetes). I get blood work done before every appointment, so every 3-6 months. Don't pay for that, either.

I am on four regular medications (two for high BP, one for diabetes, and one for cholesterol). I do have to pay my share for the meds which I think is 20% or maybe 25%.

My doctor is 80 years old but has no plans to retire because he loves his work as an internist and endocrinologist. I dread thinking of what my next doctor could be like if/when this one croaks. I think he is still quite competent despite his age.

 

[OldShooter]

... Since turning 65 and going on Medicare, my annual physicals have become Medicare Wellness Checks. In my opinion these are totally worthless. It basically consists of the doctor asking a few questions to make sure your mind still works, taking my bp (which i do occasionally at home), height/weight (also do at home) and listening to my heart. My doctor will only order blood work for me every 5 years because I have no health problems (not complaining about being healthy). ...

You are not happy. Easy: I think you need a new PCP.

Our case is a little unusual because we are in a concierge program, but we get annual physicals with four or five kinds of blood work, then see the doc who has an hour reserved for the exam and we use most of it talking. Other than the hour, you should be able to get the rest from a good PCP.

 

[MissMolly]

You all realize that it's not the doctors making these rules about the Wellness Exams, frequency of bloodwork, etc., but rather it is Medicare that made the rules? I doubt the doctors like it any better than we do.

 

[athena53]

You all realize that it's not the doctors making these rules about the Wellness Exams, frequency of bloodwork, etc., but rather it is Medicare that made the rules? I doubt the doctors like it any better than we do.

Totally agreed on that. Sometimes I feel guilty when I see what Medicare plus my supplement paid for a doctor visit, especially for specialists. The sticker price may be a bit outrageous but what they actually get is paltry.

 

[Aerides]

You all realize that it's not the doctors making these rules about the Wellness Exams, frequency of bloodwork, etc., but rather it is Medicare that made the rules? I doubt the doctors like it any better than we do.

I agree, but I've never heard anyone IRL or here, saying they can't get bloodwork more than every 5 years. Almost every time someone brings it up they talk about annual tests.

 

[momoftwo]

I second the suggestion of seeing a gerontologist.
Very happy with my youngish doc.
He's thorough, conversational, sharp and relaxed.
Is on point with old folk issues.
Never have a billing problem. They code what they code and between Medicare and supplement I owe nothing. Even on the blood work.
I do have a chronic condition that might affect the way my claims are handled.

 

[pacergal]

Wow, I think it may depend on your medicare plan?
I have been to see my PCP 3 times this year, routine and two illness/injury. Have had hands on exam, lab, X-rays, mammogram done and only one time had a $40 charge.

 

[braumeister]

I agree, but I've never heard anyone IRL or here, saying they can't get bloodwork more than every 5 years. Almost every time someone brings it up they talk about annual tests.

My doc insists on bloodwork every year and includes quite a few things that I'm happy to get but have seldom seen in the past. No problem at all. I agree that the OP's doc is shortchanging them.

 

[Sojourner]

My doc insists on bloodwork every year and includes quite a few things that I'm happy to get but have seldom seen in the past. No problem at all. I agree that the OP's doc is shortchanging them.

+1

Even though full annual physicals are largely unnecessary for most healthy people, I've found that it's easier just to go with what my doc wants. I suspect that a substantial amount of his income comes from routine physicals, and I enjoy talking things over with him once a year and seeing all my blood numbers. And it's much easier to get Rx renewals any time I need them, with no pushback, if I've had a physical within the past 12 months.

 

[teej1985]

Goodness! If my doctor was like the OP's doctor I'd be quite annoyed. I am 73 and have not paid a penny to my doctor since I went on Medicare at age 65. I think my federal employee/retiree BCBS Standard pays him. I don't think I have had one of those Medicare "Wellness checks" so far.

I see my doctor every 6 months, or every 3 months if he is not happy with my blood sugar (I have type 2 diabetes). I get blood work done before every appointment, so every 3-6 months. Don't pay for that, either.

I am on four regular medications (two for high BP, one for diabetes, and one for cholesterol). I do have to pay my share for the meds which I think is 20% or maybe 25%.

My doctor is 80 years old but has no plans to retire because he loves his work as an internist and endocrinologist. I dread thinking of what my next doctor could be like if/when this one croaks. I think he is still quite competent despite his age.

Thats because FEHB pays for annual physicals, Medicare does not.

 

[MissMolly]

I agree, but I've never heard anyone IRL or here, saying they can't get bloodwork more than every 5 years. Almost every time someone brings it up they talk about annual tests.

Medicare rules say once every 5 years UNLESS there is a specific reason/need for more frequent. For example, I am on a medication that requires bloodwork every 6 months. If I fail to to the bloodwork my doc cannot renew the prescription. So it's very dependent on the reason why. Routine with no specific need - every 5 years. Got a specific diagnosis/reason/medication - more frequently.

 

[harllee]

Medicare rules say once every 5 years UNLESS there is a specific reason/need for more frequent. For example, I am on a medication that requires bloodwork every 6 months. If I fail to to the bloodwork my doc cannot renew the prescription. So it's very dependent on the reason why. Routine with no specific need - every 5 years. Got a specific diagnosis/reason/medication - more frequently.

But I don't know of anyone over 65 that doesn't need blood work for some specific reason. Every over 65 person that I know has some reason to justify blood work. Myself, I take no prescription drugs but every once in a while my cholesterol numbers are high and my Vitamin D is low so I get blood work every year covered by Medicare. A doctor who knows the Medicare rules can code it correctly.


Remember that for many things Medicare Part D does have a deductible (around $170) and for those of us with Part G supplements we have to pay the deductible.

 

[Bamaman]

If you really get down to it, a yearly physical is just asking a bunch of questions, getting a chest x-ray and doing a blood chemistry analysis. Seldom do they find anything new just listening to your chest.

It's that laboratory work that really tells what's going on. And if you get billed for it, what's $85 anyway?

The last 2 smokers I knew hadn't been getting physicals and chest x-rays. Both had stage IV lung cancer and didn't even know it. And they both lasted about 6 months. So the chest x-ray is especially meaningful.

I'm type II diabetic and go to the doctor quarterly. And he's on top of everything with my blood work being done every visit. It's being proactive with your health that's important. And if you must pay out of pocket for a physical, so be it.

 

[MissMolly]

But I don't know of anyone over 65 that doesn't need blood work for some specific reason. Every over 65 person that I know has some reason to justify blood work. Myself, I take no prescription drugs but every once in a while my cholesterol numbers are high and my Vitamin D is low so I get blood work every year covered by Medicare. A doctor who knows the Medicare rules can code it correctly.


Remember that for many things Medicare Part D does have a deductible (around $170) and for those of us with Part G supplements we have to pay the deductible.

Well, until I got on this medication, I never had bloodwork done. My husband doesn't have bloodwork done. Other than this one medication (Humira) I don't take any other prescription drugs. Nor does my husband. So...

 

[harllee]

I have never in my life had a chest X-ray--is that part of a normal physical? I have never smoked.

 

[RetMD21]

I have never in my life had a chest X-ray--is that part of a normal physical? I have never smoked.

It was routine 40 years ago. Smokers and those who quit may be eligible for low dose chest ct for screening. People like getting lab tests so docs tend to code to justify them.

 

[Amethyst]

I don't think either of us has ever had a chest X-ray. Are they just for current smokers? Non-smokers get lung cancer, too.

As for yearly blood tests, part of their value is in showing "trends over time." A doctor (or patient, for that matter) can see if a particular set of numbers, e.g. blood sugar in a non-diabetic, is starting to trend up - a warning sign.

If you really get down to it, a yearly physical is just asking a bunch of questions, getting a chest x-ray and doing a blood chemistry analysis. Seldom do they find anything new just listening to your chest.

I.