Medicare Wellness Scam

[braumeister]

FWIW, I've been getting the same full annual physical on Medicare that I got before, no change at all. Full blood work, at least half an hour with the doc, and no or very little cost to me.

It seems to me that some doctors either don't know or don't care about the proper way to code things, which is the main reason for this thread. A real shame.

Once, some years ago, I got a bill that surprised me and I disputed it. The doc's office said "Oh, we just put the wrong code in. We'll fix it." They resubmitted it with a different code and it was paid. If I had to go through that a second time I would probably have started looking for a different doctor.

 

[Badger]

I got suckered into taking the "Wellness Check up" once and found it to being close to a scam. I was under the impression it was going to be a physical. 10 years later and I haven't been back for another one although I occasionally get reminders from the doctor. Most everything that is done I can do myself and I don't have to sit an answer the PA's or nurses questions about my diet, exercise, or habits.


Cheers!

 

[Ronstar]

I like the medicare wellness exam. I had my first one in 2020. Complete blood work, physical to include ekg. Ekg turned up an irregular heartbeat that I didn't know of. Had further stress test to rule out a problem.

Had second exam in 2021. I'll have another this year. Same doc as previous years. It's great because it's the same exam every year making it easy to compare results to previous exams. Prior to medicare, my last physical was in 2004 - the yearly schedule keeps me focused on better health because I know I have an upcoming exam to prepare for. My doc is like an upset parent with an unruly child - he chastises me if my exam results show any poor health decisions on my part. So I tend to take better care of myself partly because I don't want to hear any preaching from the doctor.

 

[Lakedog]

I'm trying to figure out if Part B is worth picking up. So far my Federal BCBS has been fantastic coverage. I don't want to pay for a premium if I don't need it or if I will get lower quality healthcare. It wouldn't be a hard decision if it didn't go up 10% every year that I am not enrolled.

Financially it is probably a toss-up but depends on your health. I went back and forth as to medicare -- last year at 65 I signed up for part b even though I had FEHB. I switched to the lowest cost GEHA plan since most FEHB plans will cover 100% of charges (other than RX costs) not covered by medicare. I have not had to pay a penny yet even though I had a couple of minor surgeries. My GEHA plan has paid everything that medicare did not, even picking up the medicare deductibles and waving their own deductibles/copays.

One reason I decided to try medicare was that I knew that I could always drop medicare part b at any time if I decided to go back to FEHB only. It's nice to have the option to drop medicare and still have great insurance. Years that you have low health costs, you would come out ahead without medicare but it sure is nice to have essentially all costs covered when you need health care. I pay around $130/month for my GEHA plan.

 

[MMxyz74]

I got on a Medicare/Medicare Supplement Plan in July and noticed that lab costs for bloodwork and PSA were a lot higher than before. My spouse is on a Medicare Advantage Plan and pays zero monthly, has a $30 co-pay for a doctor visit and a small amount for bloodwork lab charges.

I noticed the lab company has a direct pay option which appears would charge me less than going through the insurance provider. I will discuss with my doctor during my next visit to list the labwork he wants, then contact the lab company to determine if paying direct will cost me less.

As for the Wellness visit charge, it is not a problem since after paying for the initial visit my annual deductible is usually met and I should not have additional charges for the other doctors I need to see.

 

[misanman]

When people say "the doctor doesn't know how to code it so Medicare will pay", my guess is that coding it so Medicare will pay is the scam. Since I don't have any underlying health conditions (at least that have been detectable) the organization to which he belongs refuses to order what are considered by Medicare to be unnecessary. This is a very, very, large health organization so I really doubt that they don't know how to code it. I think they could code it to game the system if they wanted but they refuse to do so.

 

[braumeister]

When people say "the doctor doesn't know how to code it so Medicare will pay", my guess is that coding it so Medicare will pay is the scam. Since I don't have any underlying health conditions (at least that have been detectable) the organization to which he belongs refuses to order what are considered by Medicare to be unnecessary. This is a very, very, large health organization so I really doubt that they don't know how to code it. I think they could code it to game the system if they wanted but they refuse to do so.

I can't help but think there is something missing from your story. You said you can only get blood work every five years, but there is no such Medicare rule. Perhaps it would be worth your while to have more of a conversation with your doctor or his office people?

 

[Helen]

Financially it is probably a toss-up but depends on your health. I went back and forth as to medicare -- last year at 65 I signed up for part b even though I had FEHB. I switched to the lowest cost GEHA plan since most FEHB plans will cover 100% of charges (other than RX costs) not covered by medicare. I have not had to pay a penny yet even though I had a couple of minor surgeries. My GEHA plan has paid everything that medicare did not, even picking up the medicare deductibles and waving their own deductibles/copays.

One reason I decided to try medicare was that I knew that I could always drop medicare part b at any time if I decided to go back to FEHB only. It's nice to have the option to drop medicare and still have great insurance. Years that you have low health costs, you would come out ahead without medicare but it sure is nice to have essentially all costs covered when you need health care. I pay around $130/month for my GEHA plan.

What criteria would you use to decide to drop Part B? The two insurance plans insulate you from knowing what your out-of-pocket costs would be.

Part B will cost either $170 or $238 per month depending on Roth conversions and in five years Social Security. BCBS Basic would rebate $800 per year for Part B.

I had a brain aneurysm procedure, I've had three colonoscopies, I saw a lot of specialists and had a lot of ongoing tests for Meniere's, had a growth removed from my eye and had my appendix out under Federal BCBS. I have paid little out of pocket. For example, my appendix surgery cost me $300 as did the eye surgery.

I recently read someone underwent cancer treatment with Federal BCBS and paid little out of pocket as well.

I'm not convinced the Part B premiums would save enough in out-of-pocket costs over my remaining years to make it worth my while. OTOH, if I wait too long to decide the penalty of 10% per year will make it even less cost effective - probably to the point of no return.

 

[Helen]

When people say "the doctor doesn't know how to code it so Medicare will pay", my guess is that coding it so Medicare will pay is the scam.

Or maybe Medicare is the scam. I can't believe annual blood work isn't considered essential, especially in older people. What's the point of going to a doctor appointment if they are just going to check vitals? I could go to CVS and have that done.

 

[Lakedog]

What criteria would you use to decide to drop Part B? The two insurance plans insulate you from knowing what your out-of-pocket costs would be.

Part B will cost either $170 or $238 per month depending on Roth conversions and in five years Social Security. BCBS Basic would rebate $800 per year for Part B.

I had a brain aneurysm procedure, I've had three colonoscopies, I saw a lot of specialists and had a lot of ongoing tests for Meniere's, had a growth removed from my eye and had my appendix out under Federal BCBS. I have paid little out of pocket. For example, my appendix surgery cost me $300 as did the eye surgery.

I recently read someone underwent cancer treatment with Federal BCBS and paid little out of pocket as well.

I'm not convinced the Part B premiums would save enough in out-of-pocket costs over my remaining years to make it worth my while. OTOH, if I wait too long to decide the penalty of 10% per year will make it even less cost effective - probably to the point of no return.

My plan is to re-evaluate depending on how much medicare premiums increase over time while comparing the annual medicare cost (premiums) to max out of pocket costs with FEHB plan options. When I start RMDs, I will be in a higher IRMAA bracket so that might be another reason to drop medicare in the future.

I do have an idea of what my costs would be without medicare as I know what deductibles and copays are waived by my FEHB plan and also know what % GEHA would pay (without medicare). I was on medicare for about 7 months last year, and estimating health care costs without medicare, I believe I would have come out about the same cost-wise without medicare -- with just GEHA, I would have paid about what my medicare premiums were for that period of time.

It is a tough decision as healthcare needs can vary greatly form person to person as well as over time for an individual. I have been lucky and have never had any health issues until right after going on medicare when I had a couple of skin cancers (one melanoma). If I continue to be clear with no melanoma recurrence and otherwise good health, that might also sway my decision about medicare part b.

 

[RetMD21]

When people say "the doctor doesn't know how to code it so Medicare will pay", my guess is that coding it so Medicare will pay is the scam.

exactly

 

[misanman]

You said you can only get blood work every five years, but there is no such Medicare rule.

A simple Google search showed this:
Blood tests for heart disease screening:

Medicare covers blood tests every five years to test cholesterol, lipid and triglyceride levels.

My note: If you have health issues or are taking drugs to lower your cholesterol, you would have your blood checked more regularly, but those tests would be coded as “diagnostic”, meaning you would have a 20% co-pay. This might be covered by your Medicare supplement, depending on which one you have. Medicare Advantage plans each have their own co-pay rules for diagnostic tests and lab services.

If it's on the internet it must be true, right?

 

[braumeister]

those tests would be coded as “diagnostic”, meaning you would have a 20% co-pay.

Even if you had no supplement, 20% of the cost of a blood test once every year or two shouldn't be a lot of money. Personally, I think it's worthwhile.

 

[Sarah S]

A simple Google search showed this:
Blood tests for heart disease screening:

Medicare covers blood tests every five years to test cholesterol, lipid and triglyceride levels.

My note: If you have health issues or are taking drugs to lower your cholesterol, you would have your blood checked more regularly, but those tests would be coded as “diagnostic”, meaning you would have a 20% co-pay. This might be covered by your Medicare supplement, depending on which one ?

My limited medicare experience as a patient is diagnostic blood work is covered in full. I had tests on two separate occasions and neither I nor my supplement paid any of it. Part b paid all the allowed charge. I have original medicare a and b and a supplement. I do not have any special corporate or federal plan I was “ chatting” with medicare on their website and asked about it and they confirmed no deductible for diagnostic tests. I believe there are rules about frequency for some tests even with a diagnosis. I think glycohemoglobin is 6 months for diabetes though I am not sure

 

[braumeister]

My limited medicare experience as a patient is diagnostic blood work is covered in full.

Yes, that's just what some of us have been saying. Nobody seems to be quite sure why others have had to pay for it.

 

[aja8888]

As I said in a previous post about my 13 years on Medicare, as part of the ANNUAL Wellness Exam, bloodwork is covered. I also have them test PSA and testosterone for me and that gets covered also. Been this way for 13 years and two different doctors.

Just make sure you doc's office knows how to code the Medicare submittal. Use a doc that is experienced in dealing with Medicare patients.

I had two hips replaced and my out of pocket was $0.00. (Medicare + Supplemental Ins - Full Plan F).

 

[HGTVFanatic]

What are these Medicare Wellness exams that you speak of? Never heard of them and have been on Medicare for three years. Of course, I have been getting regular blood work for over ten years because of a liver problem but never heard of these wellness exams. Are they required? If not, I wish they were because my spouse is 69 and has been to the doctor probably three times since he was born. He refuses. It's disturbing.

 

[braumeister]

What are these Medicare Wellness exams that you speak of? Never heard of them and have been on Medicare for three years.

Sounds as if you might benefit from looking at the Medicare handbook. You can download a copy here:

https://www.medicare.gov/medicare-and-you

 

[RetMD21]

Boomer benefits has a new video on Medicare and blood tests including 5 year cardiac screening etc. If your doctor does some tests for screening but miscodes to get them paid that is his/her problem if audited. If the test is disallowed by Medicare your supplement won't help you

 

[aja8888]

What are these Medicare Wellness exams that you speak of? Never heard of them and have been on Medicare for three years. Of course, I have been getting regular blood work for over ten years because of a liver problem but never heard of these wellness exams. Are they required? If not, I wish they were because my spouse is 69 and has been to the doctor probably three times since he was born. He refuses. It's disturbing.

Naw, going is not required. I have a friend who I see once in a while who is 72 and has not been to a doctor since his employment physical decades ago. He's bulletproof and will never die. At least that's what he thinks.

 

[aja8888]

Boomer benefits has a new video on Medicare and blood tests including 5 year cardiac screening etc. If your doctor does some tests for screening but miscodes to get them paid that is his/her problem if audited. If the test is disallowed by Medicare your supplement won't help you

Thanks for the video and I noted that for the Wellness exam, Medicare won't cover any blood tests. For me, after 13 years of Wellness exams, the screening blood work I get each year has been covered. I guess it depends on how the doc's office does the coding.