This is not a political blog entry. This is an entry of a personal story, which illustrates the craziness and absolute lunacy of our healthcare system in an event that happened to me this week.
As a state employee of Wyoming, I get up to $500 for “Wellness Visits,” which are supposed to be preventative care. No deductible, no fee. Free. Up to $500. Not only that, but a wellness exam is mandatory for you to get a discount of $480 of your health insurance premiums throughout the year – a good deal, to say the least.
On July 12, I went in for my annual physical exam – my wellness visit. It encountered all the regular annual physical stuff – blood pressure, pulse oxygen screening, weight, height, the female stuff – you get the gist. And, I should point out – this is usually my only visit to the doctor during the year.
Three weeks later, I got a bill from my doctor for $50 that my insurance didn’t cover. Well, it’s supposed to be covered, up to $500, like I said, and the original bill was $196. So I called the insurance company.
Me: “Why did I get billed for a wellness visit when it’s supposed to be covered up to $500?”
Helpful and perky insurance agent: “Because of the way the doctor coded your visit, it was billed as a visit with other services. You need to get your doctor to change the way they billed it. If they bill it as a wellness visit, we’ll cover it.”
So then I call my doctor’s office.
Me: “Yes, hello – I got a bill for my wellness visit, and I was told that you need to re-bill the insurance company so they’ll cover the entire exam.”
Also nice lady: “Let me see here – let me look up your visit.”
Lady: “Oh, well it says here that you talked to the doctor about migraines, so that’s not a wellness visit.”
Me: “First of all, I’ve had a history of migraines for the past four years. She simply asked me how the medication I’m on is going, and refilled my prescription. Isn’t that part of a routine annual exam?”
Lady: “Well, if you discuss any symptoms, that’s not technically a wellness exam.”
So let me get this straight. In a program that is supposed to have a preventative focus, if you talk about anything that might require further care, it’s not covered. So if you happen to be having regular stomach pains lately, they’d rather you say nothing and then later have to treat your cancer rather than getting it early and taking out a tumor.
The doctor’s office lady told me that she knows it’s stupid, but now she has to get a provider to review my file and make the determination of whether it can be re-billed as a wellness visit or not.
Regardless of the outcome, I already have my game plan for my next mandatory wellness visit, about a year from now. When the doctor asks how I am and if I’m having any problems, I’ll just look at her and respond: