Medicare Wellness Scam

[athena53]

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.

Yeah, that's why I like to track my bloodwork. I have a low white blood cell count (but rarely get sick- go figure). New PCP mentioned it and I just told her it had been like that for years. I probably saved myself (and Medicare) a bunch of tests.

I remember when chest X-rays were a big thing. I remember getting 3 in one year (X-ray mobile at HS, pre-admittance testing at hospital later in the year, required as part of health info my college required). That was 1971. I didn't want to bother having the initial one sent around (they were actual films in those days) so I just took them as required. Haven't had one since.

 

[misanman]

I am 75 and the doc will authorize bloodwork every 5 years. I think last year was the year. Since there was nothing unusual it's another 4 years for me.

 

[Teacher Terry]

I don’t do the Medicare wellness exam because it’s stupid. I do see my primary doctor yearly and I have yearly blood work.

 

[aza455]

I don’t do the Medicare wellness exam because it’s stupid. I do see my primary doctor yearly and I have yearly blood work.

And is the bloodwork fully covered and paid by Medicare?

 

[meleana]

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.

My husband and I set up physicals every year and anyway we are both on medication now anyway so the doc follows up and we need our prescriptions renewed. ( I’m on a cholesterol med and he’s on a high blood pressure med).

But the doc always orders blood work first before the office visit. We have Plan G and have to pay the deductibles.

I never even bothered with mentioning a Wellness visit even before I was on the medication. I just called and scheduled a physical. (I always did so when I was working and had employer health insurance also and didn’t have to pay for the annual physical ).

 

[aja8888]

I must be lucky. My Medicare physical is scheduled every year around May. My Doc does the check up asks me all kinds of questions about my health and if I have any concerns, and then we take blood. I get the whole "magilla" of tests done including PSA and testosterone. Last year, she did an EKG on me and we went over all the blood work. Medicare paid for the whole thing, as it has done for 13 straight years now.

Last year, my Doc ordered a chest X-ray for me as a preventative check and medicare paid for that too.

I am fortunate as I have no heath issues at 78. But I have worn out a couple of hips and broken a bunch of bones over time.

 

[eyenitnoy]

It's a cash grab.
Find a new doctor, preferably one who is independent and not a hospital/group employee. (They are becoming more rare each year.)

 

[harllee]

It is all up to the doctor and his staff--how knowledgeable they are to code things correctly so Medicare will pay for the physical and blood work. I had a GP who did not know how to code Medicare correctly do so I changed to a geriatric physician who knows how the codes work and Medicare now pays for the physical and blood work, it is that simple.

 

[friar1610]

I do the Wellness Visit every year, always get blood work done and never seem to get billed for it. Probably for one (or more) of the following reasons:

- I have a couple of preexisting conditions (e.g., controlled HBP, controlled borderlines high cholesterol) that justify the blood work.
- my doctor knows how to code to get things accepted.
- my Medicare supplement (Tricare for Life) picks up what Medicare doesn’t.

I have no complaint with the thoroughness of my annual visits.

 

[GeneS]

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?

Check on how your BCBS coverage will change if you sign up for Medicare part B. My wife has Federal BCBS for both of us and with Medicare part B coverage BCBS waives all co-pays and deductibles. In a year when we both have no major health problems we may pay a bit more but when we have had major medical expenses we have saved a LOT. Also, are you still working? If you are that would make BCBS your primary insurance and might change things. And there's the permanent premium penalty that increases every year that you don't sign up for part B. So be sure to investigate your specific situation. The annual wellness exam would be a minor consideration, IMHO.

 

[Koolau]

My doc orders so many blood tests that I'm anemic and so many X-rays that I have radiation poisoning (ALL JUST KIDDING!) But he does get blood work at least twice a year as he is following several conditions. MC and my supplement cover most everything, though I go through the bulk of my $6K/year additional supplement (like an HSA) that my megacorp provides. It covers premiums and co-pays, meds, etc. until it runs out - which it has been doing of late.

I too wonder about the MC wellness thing. I honestly think it's one of the ways docs are staying in business these days. They get VERY little from MC otherwise and this is one way to get a bit more. I'm not defending it as such, but there are several factors that are not independent of each other. I know we all believe doctors are rich (and the specialists certainly can become so) but most PCPs are just well paid, hard w*rking, long-hour combinations of scientist, technician, and artist. SWAG is they make maybe $150K/year which really isn't much for what they paid for school. Not really taking a "side" but just sayin' so YMMV.

 

[Helen]

Check on how your BCBS coverage will change if you sign up for Medicare part B. My wife has Federal BCBS for both of us and with Medicare part B coverage BCBS waives all co-pays and deductibles. In a year when we both have no major health problems we may pay a bit more but when we have had major medical expenses we have saved a LOT. Also, are you still working? If you are that would make BCBS your primary insurance and might change things. And there's the permanent premium penalty that increases every year that you don't sign up for part B. So be sure to investigate your specific situation. The annual wellness exam would be a minor consideration, IMHO.

I am no longer working. As far as I can tell, the only change to my Federal BCBS would be that it becomes secondary insurance. Did your Federal insurance change in coverage with Part B?

So far, my out of pocket costs for the past 25 years have been very little, including for the brain aneurysm. My appendix removal cost me $300 out of pocket. I read online that someone went through major cancer treatment before going on Medicare and paid very little out of pocket.

I have Checkbook's 2022 guide and the Social Security & Medicare Guide. I don't think Plan B will really buy me much.

When you say Part B has saved you a lot, do you mean in deductibles and copays?

 

[travelover]

I quit doing the "wellness exam" as it seemed like the primary intent was to document my descent into senility. I do go in once a year to get prescriptions renewed and a blood test which seems to get covered by Medicare, though I don't know how it is coded.

 

[imnontrad]

Yes, I agree, the annual "Medicare physical" is totally useless. I need to keep track of my A1C and cholesterol levels. I consider a once a year check of these to be the minimum level of requirements.

 

[RetiredHappy]

My husband is on Medicare and I am 5 years away. We have a concierge doctor as our PCP and he orders blood work every 6 months and he has never had problems in getting paid. He also does a Mayo clinic type annual physical where we get EKG, hearing, breathing and cognitive tests. I also see an ophthalmologist, OB/GYN and gastroenterologist annually, allergist/immunologist twice a year and dermatologist half a dozen times a year. My husband sees his ophthalmologist and retinal specialist twice a year.

I would find a different PCP who would actually take time to examine you and order blood work at least once a year.

 

[Teacher Terry]

Aza, yes the blood work is fully covered.

 

[John Galt III]

I always make a big deal of stating that I am in only for a FREE wellness exam, on the way in, during the exam, and on the way out. I have been charged in the past an office visit fee tacked on to a physical, so I know all about that scam, yes. I have a medicare advantage plan, and I never get charged for the wellness exam, probably due to my vigilance. I get blood work every year ordered st the exam, too. I talked to the Dr. about the coding of the tests so they are paid for by insurance. I also call the ins co to verify all the tests will be covered, if I am unsure. So far, so good. I have a $10 copay, for blood work, and that is all I have been charged. I just got a brochure from my Medicare Advantage plan telling me to schedule my annual 'routine physical'. (Not a wellness visit). I really don't want to even risk it. They say the physical is 100% free to me. I just don't trust it. The doctor's office will screw it up somehow, and blame the ins co, and try to charge me for x, y, z lol. By the way, I looked up the EOB for a wellness visit, and the doctor's office got some huge payment, like $300 for it. They charged $300 and yes, the ins co paid them the whole $300. Amazing.

 

[Gotadimple]

Jhon Galt III: People need to be paid for their time. Running a clinic is expensive, and they never get from Medicare the full cost of their expenses to run a clinic (that gets made up on the private side when they see private patients using company health plans).

When it comes to running a clinic, the flow of $ is just as important as the quality of care. So, a Medicare Wellness visit is a way to assure PCPs that they are seeing patients and getting something for their time. How much they earn for a wellness visit depends on the payment schedule they negotiated with the health plan (or if you are on traditional Medicare, what CMS says they will pay - no negotiation allowed).

In addition, Quality Assurance studies done by independent agencies, have found that for reasonably healthy patients with stable conditions, a full physical doesn't add any new info for the PCP to treat, so it's a waste of resources (but a source of income).

At a Wellness visit, a PCP is required to do basic checks along with a cognitive test. If you have other issues that require more review/testing, then you make a plan for a separate visit, and pay a separate co-pay.

It doesn't matter whether you are on traditional Medicare, Medigap, or Medicare Advantage, all of these are controlled by CMS and they make the treatment and payment rules. To those who think it's a rip-off, try getting a physical exam (because you think that it's high quality health care) from a concierge physician (no insurance involved) for less than $300. It doesn't exist.

 

[Helen]

In addition, Quality Assurance studies done by independent agencies, have found that for reasonably healthy patients with stable conditions, a full physical doesn't add any new info for the PCP to treat, so it's a waste of resources (but a source of income).

At a Wellness visit, a PCP is required to do basic checks along with a cognitive test. If you have other issues that require more review/testing, then you make a plan for a separate visit, and pay a separate co-pay.

What is done in a full physical that isn't done in a wellness check?

I haven't started Part B yet. My PCP goes over everything with me, sleep, diet, exercise, vaccinations, concerns about colonoscopy results, vitals and orders blood work. Would this change under a wellness check?

 

[ls99]

I do the wellness visit thing. For the past 4 or 5 years with one exception, are the the only doc visits. BTW I do not take any prscription or OTC meds. @ age 74, minor miracle.
The one time was last summer, for a rash on ankle,I ended up with a newly minted doc just out of internship. He took the place of the Doc. who retired. He thought anti biotics solve all problems, if not, more powerful versions must work better if first two rounds of weaker stuff fail. Never mind destruction of digestive system.
My experience now says, never ever allow a newbie doc to treat me. I called a dermatology office, Nurse practitioner figured out the problem, topical stuff for one week, all was well. She muttered, damn doctors all do the same pill crap. Did not need follow up. Digestive system took months to recover.

Seems newbie Doc's have nice shiny tools in their heads, kinda like new mechanics with fancy toolbox, nil experience.
So my next wellness is in july, will insist on seeing a doc with no less than ten years eparience. An experienced Doc can detect all sorts of stuff simply by looking. Often use tests to confirm initial opinion. Or as CYA.

The oldtimers' adage: The exam begins the moment you lay eyes upon the patient and smell them.

YMMV

 

[harllee]

What is done in a full physical that isn't done in a wellness check?

I haven't started Part B yet. My PCP goes over everything with me, sleep, diet, exercise, vaccinations, concerns about colonoscopy results, vitals and orders blood work. Would this change under a wellness check?

At my "Medicare wellness check" with my prior physician nothing was done really. I saw the PA, did not see the doctor, no blood work, did not even listen to my chest, just asked a few questions. In my opinion totally worthless. So I changed to a geriatric physician who gives me a more thorough exam including blood work.

 

[mpeirce]

Wow. People here seem more interested in saving a buck or even gaming the system.

I honestly don’t mind paying for medical treatment. I’m not on Medicare, but my private insurance is there to cover the big stuff - if I get sick or injured. I don’t sweat the small charges.

 

[harllee]

Wow. People here seem more interested in saving a buck or even gaming the system.

I honestly don’t mind paying for medical treatment. I’m not on Medicare, but my private insurance is there to cover the big stuff - if I get sick or injured. I don’t sweat the small charges.

But the full physical and blood work was not a small charge to me--I was billed about $1000 because the doctor did not know how to code my treatment to get Medicare to pay so I changed to another doctor. I finally got the $1000 bill reduced but it took many hours. Just wait until you get on Medicare, the you will see what we are talking about.

 

[Helen]

Wow. People here seem more interested in saving a buck or even gaming the system.

I honestly don’t mind paying for medical treatment. I’m not on Medicare, but my private insurance is there to cover the big stuff - if I get sick or injured. I don’t sweat the small charges.

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.

 

[Koolau]

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.

IIRC you must pick up Part B if you are eligible or else you will be charged much more for it later. DO research this as I'm not certain and I'm sure there are a lot of rules involved so YMMV.