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.”
Cool.
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.”
Waiting …
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:
“I’m well.”
HAHAHAHA - It's not just Wyoming that does this stupid shit. I got a bill not too long ago for the same thing!! If you go in for your reg yearly check up the Dr is SUPPOSED to review your file and go over everything. That's a good Dr, that's what they're supposed to do to make sure you don't need further treatment.. blahblahblah... I fought mine too - it's only $10 for mine, but it's the principle behind it. I went in for my physical, the GYN asked about a chronic problem that will never ever go away and they send me a bill that it's not covered under a 'wellness exam'. How is that not covered? I'm going in and they're making sure I'm well damn it! If the patient brings up a list of other things - my foots turning black, it burns when I pee, or there's a big giant boil on my ass... then yes,don't cover it. But when the Dr asks you about what's in your file then suck it up and pay the damn bill! Stop trying to find mediocre ways to make the patient pay =op
ReplyDeleteDon't even get me started on this topic! I've also has a similar experience, where my husband went in for a visit, which they coded as an "Emergency" visit, even though they couldn't get him in for 2 days, and they didn't prescribe anything for his sore throat because by that time, it was getting better on its own. My phone calls weren't so nice, as I ended up yelling at the lady who comes up with those stupid codes at a doctor's office because she wouldn't just resubmit it as a non-emergency visit. She was exceptionally rude, and I ended up writing a nasty review on CitySearch. We ended up paying the nearly $200 just to avoid getting a collections agency phone call.
ReplyDeleteOn a totally separate occurrence, I called my insurance company preemptively to be sure that a certain test would be covered - and even provided them with the codes that the doctor’s office would submit the test under. After being told those services would be covered by two different people (I wasn't fully satisfied with the answers of the first person I spoke to, so I called back), they billed me anyway. What'd I do, I called them again, stated that I'd had this conversation with them and was told it was covered. The lady pulled up my file, and sure enough, saw that I had called. She waived all associated costs. They must think I'm stupid enough to just pay the $180 without realizing what it was for.
In short, I hate those stupid codes.
Oooooo Kat. You're gonna flip when you hear the story I'm gonna tell ... when I've mustered the energy to write about it. Suffice it to say my dentist's office just credited my Discover account almost $600 for what I can only describe as the biggest clusterfuck in the history of dental billing.
ReplyDeleteYour story has enraged me all over again.
Have they corrected the $50 charge?