Is this normal billing for your annual?

[robinsmommy]

Last time I went in for an annual, I talked about health issues that were ongoing issues and things that I had been treated for before, and new ones. Seems kinda normal, right? When I got the bill, they billed me for an annual AND for an additional regular (sick) visit. The way our insurance works, the first 3 sick visits are free, so I lost one of those visits.

I don't understand why they didn't just bill me for an extra long annual - in the end, it would have been cheaper for me as I NEEDED those sick visits that year. They said because I talked about other issues, things I was/had been/would need treatment for, that was the way it was done.

I have never heard of this. Is this how it works with your Dr?

She's ok, not great, not awful, but if this isn't standard practice (and I've never had it done this way before), I'd find someone else, un-fun as it is to, uh, break-in a new Dr.

????

[waitingforgrace]

I've never heard of billing that way but we are also on a co-pay so maybe that accounts for the difference. I think you should consider finding someone else it seems totally normal to me that as part of an annual exam you discuss current and ongoing health issues.

[ett]

I've never had my annuals billed that way either. Isn't the whole point of the annual to check up on past issues and to see if you have any new issues. You should be able to discuss all those things at the appt. It sounds like the office is just trying to milk more money out of the insurance company. If you don't love this doc, I would probably try to find a new one.

[WolfpackMom]

I wonder if it was billed that way because of the coding sheet that is usually checked off an an appointment, and then your insurance took it from there. For example, DS' 12month appt was checked off as a well visit, but then an ear recheck, nebulizer treatment, breathing check and asthma diagnoses were all also checked off on the little coding sheet. I still only had the single copayment and havent heard of losing a sick visit out of it yet, but maybe thats why - because they checked off the little boxes as you discussed issues?

[LMPC]

This happened to me at my last annual too. We talked about my mom's breast cancer history and how I probably should have a baseline mammo done soon. Then dr (who I love and am not going to be leaving because of this) decided that my breasts felt fairly dense (I knew this) and that it was better to have the mammo done now rather than wait. So I was billed for the annual + an office visit. It makes no sense to me, but I think this is becoming more the norm. A breast exam is part of the annual...so what should dr's do, tell us to come back for another visit to explore that issue more fully...does not make sense. It should be all included in the one visit. Whatever.

[LMPC]

I wonder if it was billed that way because of the coding sheet that is usually checked off an an appointment, and then your insurance took it from there. For example, DS' 12month appt was checked off as a well visit, but then an ear recheck, nebulizer treatment, breathing check and asthma diagnoses were all also checked off on the little coding sheet. I still only had the single copayment and havent heard of losing a sick visit out of it yet, but maybe thats why - because they checked off the little boxes as you discussed issues?

Yes, this is pretty much what happened in my case...he gave me an ICD-9 code (diagnostic code) and therefore had to also put in another CPT (procedure code) and then that's what I was billed for.

[cuca_]

That doesn't sound right. I would call your insurance and bring it to their attention.

[robinsmommy]

But wouldn't the "annual" label sort of override all the other boxes checked off Wolfpackmom?

I guess that sadly, I have to say that having some understanding of how insurance billing works is a prerequisite for my Dr's, and that them labeling things in a way that costs me more money (and gets them a LOT more, as the "rate" for their time is cheaper for a longer visit than to add on a whole 'nother visit) is milking my insurance.

I just wondered if this was a new thing, since it sounds like it isn't I'll find someone new.

The only other time that I've had this done was when an EXTRAORDINARILY expensive piece of special medical equipment was used to look at a hole in my eardrum at the ENT's. They billed another visit to cover the cost, which I resented but understood more.

[jgenie]

My doctor's office has signs posted in each room stating that some insurances only cover one item at a time and if we need to discuss a current problem during a physical it will be billed as two visits. That's not the exact wording but more or less.

[robinsmommy]

I called the insurance, and she billed for a very expensive, but still "partial" medical visit along with the annual. I guess it is becoming more common, and that I am old fashioned. I think an annual should be treated like a long visit and that should be be able to talk about on-going issues rather than just laying there while they do the exam.

I do think I'll find someone else, though. I don't think it's standard practice everywhere.

[lablover]

Last time I was in my gyn office I noticed a sign that said something along the lines of - If you have a problem you need to discuss you need to make a separate appt as these cannot be addressed at the annual. I guess this is becoming the norm.

[Tondi G]

Last time I was in my gyn office I noticed a sign that said something along the lines of - If you have a problem you need to discuss you need to make a separate appt as these cannot be addressed at the annual. I guess this is becoming the norm.

I can't believe it's becoming the norm... thats rediculous! I went in for my annual gyn visit and had been feeling off as it was so I asked her to do a swab since she was doing the Pap anyways. I had been treating what I thought was a yeast infection only to find it was a bacterial infection... who knew! Insurance was billed for an annual well woman visit.

[sariana]

What a lot of rot.

This is why I'm glad we have our HMO. Our carrier emphasizes preventive care. They WANT to deal with problems while they are little. Billing patients extra for talking about other issues will lead to patients' not addressing these issues, which can cause those little issues to turn into big ones.

Not a smart plan IMO.

[Melaine]

This is NUTS. The health care system is so incredibly screwed up.

[gatorsmom]

My doctor's office has signs posted in each room stating that some insurances only cover one item at a time and if we need to discuss a current problem during a physical it will be billed as two visits. That's not the exact wording but more or less.

:yeahthat: My dermatologist has a sign up saying essentially this. None of my OBGYNs have, though, and I agree with all the pps who said that an annual well-check should allow for you to ask questions. And the fact that there was no warning about this (like a sign in the waiting room, or she could have warned you while you were talking), is really inconsiderate, imo. If this created a problem for me, I'd definitely complain to the Dr. office about it. You should have been warned.

I'd call back and ask them to specify exactly what services/items you are paying for in an annual visit? Breast exam? pap smear? discussion of ONE topic? Anything more than that needs to be billed extra?

I'd find another Dr. I wondered what other tricks she's got to get more money from insurance??

[hellokitty]

Our peds office is awful about this. If you bring your child in for a well child visit and have other issues or if your child happens to be sick at the time of your well child visit they throw a huge stink over it and insist that you make another appt. They won't even let me schedule two well child appt for siblings back to back. I need to find a new gyn, but my assumption would be that the annual would cover any questions I have, so I'd be pissed if I got charged a whole other appt for that!