Billing for an "office visit" with free preventative care - is this the new healthcare scam?

[Anonymous]

This has happened to me twice now. We go in for a physical which is fully covered by insurance and then end up receiving a bill for an "office visit" for $150+.

The first time it was for me and I was told it was because I "discussed a new issue" with my doctor. 1. - I didn't. He asked if I needed a refill for a condition I've had for 20+ years. I said yes. B. Even if I did bring up a minor issue, do they not want us to answer honestly when they ask us health questions or ask if we have any concerns? We should just say nope!

Then it happened again with my daughter at a completely different practice. The NP (because of course the ped doesn't do physicals) decided she wanted my daughter screened for a minor issue by a specialist. An issue that we did not ask about and were not concerned about. So she handed me a piece of paper with some pre-typed names on it. Turns out that writing "referred patient for X" is enough to get you billed for an "office visit." So then I took my daughter to said specialist (another $150+) for them to laugh and say my daughter definitely does not have X condition. And then I received the bill from the Ped's office for an "office visit" instead of the well visit.

In both cases, the conversation about the "issue" was less than 60 seconds and not initiated by me. After some back and forth and arguing I was able to get the charges removed. But both required persistence, multiple phone calls and talking to more than one person. Which I guess they are counting on a certain percentage of people not doing. In both cases they acted like they are doing me a favor rather than correcting their own error (best case scenario) or outright billing fraud (worst case scenario.)

So just, be very aware and vigilant for this, particularly if you are on a high deductible plan.

[Anonymous]

It’s a billing thing. The preventive care visit diagnosis code doesn’t include any of these other things that were addressed. So if thyroid or anxiety meds were refilled, or patient was referred to Derm for a skin concern or whatever it was, those have separate diagnosis codes and need to be linked to a separate office visit. Many health care offices have signs in waiting room letting people know that this will happen during a PCV visit. Listen we (health care providers) hate it too. But electronic medical record systems kind of require you to play by insurance company and billing rules.

[Anonymous]

Anonymous wrote:It’s a billing thing. The preventive care visit diagnosis code doesn’t include any of these other things that were addressed. So if thyroid or anxiety meds were refilled, or patient was referred to Derm for a skin concern or whatever it was, those have separate diagnosis codes and need to be linked to a separate office visit. Many health care offices have signs in waiting room letting people know that this will happen during a PCV visit. Listen we (health care providers) hate it too. But electronic medical record systems kind of require you to play by insurance company and billing rules.

It never happened to me until last year. It's a money grab.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It’s a billing thing. The preventive care visit diagnosis code doesn’t include any of these other things that were addressed. So if thyroid or anxiety meds were refilled, or patient was referred to Derm for a skin concern or whatever it was, those have separate diagnosis codes and need to be linked to a separate office visit. Many health care offices have signs in waiting room letting people know that this will happen during a PCV visit. Listen we (health care providers) hate it too. But electronic medical record systems kind of require you to play by insurance company and billing rules.

It never happened to me until last year. It's a money grab.

Doctors are getting squeezed too. It's a billing thing. They could have, probably should have, always been doing it. Now the ones who were lax are doing it too.

[Anonymous]

It happened to me too! So dodgy. It really puts me off getting my kids physicals - if I have to pay $150 every time I go to the doctor, why do I even have insurance?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It’s a billing thing. The preventive care visit diagnosis code doesn’t include any of these other things that were addressed. So if thyroid or anxiety meds were refilled, or patient was referred to Derm for a skin concern or whatever it was, those have separate diagnosis codes and need to be linked to a separate office visit. Many health care offices have signs in waiting room letting people know that this will happen during a PCV visit. Listen we (health care providers) hate it too. But electronic medical record systems kind of require you to play by insurance company and billing rules.

It never happened to me until last year. It's a money grab.

Doctors are getting squeezed too. It's a billing thing. They could have, probably should have, always been doing it. Now the ones who were lax are doing it too.

Wait. It's not the doctors getting squeezed, is it? It's the private equity company that is getting the profits, right? So what you are saying is that the $150 is necessary so the head of the private equity company can get a larger boat.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It’s a billing thing. The preventive care visit diagnosis code doesn’t include any of these other things that were addressed. So if thyroid or anxiety meds were refilled, or patient was referred to Derm for a skin concern or whatever it was, those have separate diagnosis codes and need to be linked to a separate office visit. Many health care offices have signs in waiting room letting people know that this will happen during a PCV visit. Listen we (health care providers) hate it too. But electronic medical record systems kind of require you to play by insurance company and billing rules.

It never happened to me until last year. It's a money grab.

Doctors are getting squeezed too. It's a billing thing. They could have, probably should have, always been doing it. Now the ones who were lax are doing it too.

You're just going to scare people away, or make them afraid to say anything to you that could be construed as an "issue." Also, as I stated, I didn't even raise any of the issues in question. The doctors did. That is some shady BS. I'm going to start all future visits with a disclaimer to the doctor that I don't wish to discuss anything that will convert my well-visit to an "office visit." If that isn't okay with them, I will find someone else.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It’s a billing thing. The preventive care visit diagnosis code doesn’t include any of these other things that were addressed. So if thyroid or anxiety meds were refilled, or patient was referred to Derm for a skin concern or whatever it was, those have separate diagnosis codes and need to be linked to a separate office visit. Many health care offices have signs in waiting room letting people know that this will happen during a PCV visit. Listen we (health care providers) hate it too. But electronic medical record systems kind of require you to play by insurance company and billing rules.

It never happened to me until last year. It's a money grab.

Maybe so, but not by your doctor. You can’t make a referral or send a prescription without a diagnosis code attached, and if it’s for something not covered by preventive /well care then the billing office/coder types will pick it up so it gets added on.

[Anonymous]

It is the most frustrating thing ever. LY they gave my child a mental health questionnaire (I think it was 10 questions) at the annual exam. They answered sometimes about anxiety and since it was not a 100% no, they said it was a mental health visit too and it kicked us into a copay. I think the doctor spent maybe 1-2 minutes asking additional questions about that response. TY when we went I asked my child if they were anxious or feeling they needed to talk to anyone. they said no, I said make sure you select no across the board. I would rather pay someone the copay to spend 30 minutes or more to talk with you then a doctor for 1-2 minutes.

[Anonymous]

Anonymous wrote:It is the most frustrating thing ever. LY they gave my child a mental health questionnaire (I think it was 10 questions) at the annual exam. They answered sometimes about anxiety and since it was not a 100% no, they said it was a mental health visit too and it kicked us into a copay. I think the doctor spent maybe 1-2 minutes asking additional questions about that response. TY when we went I asked my child if they were anxious or feeling they needed to talk to anyone. they said no, I said make sure you select no across the board. I would rather pay someone the copay to spend 30 minutes or more to talk with you then a doctor for 1-2 minutes.

Those questions are useless too. They have no scientific basis, some random just made them up, it is clear that a great deal of anxiety or depression is situational and not medical.

[Anonymous]

If the doctors in the practice are actually aware of this shadiness going on, then shame on them. It's one thing if it actually makes the visit take longer or they have to do extra work. 60 seconds of talking that you would have done anyway is just a scam.

[Anonymous]

Anonymous wrote:If the doctors in the practice are actually aware of this shadiness going on, then shame on them. It's one thing if it actually makes the visit take longer or they have to do extra work. 60 seconds of talking that you would have done anyway is just a scam.

Of course they know. Private equity bosses give doctors quotas.

[Anonymous]

You need to find a new (better) pediatrician. Ours doesn't do that and yes, the pediatrician conducts the physicals. Same for your GP.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If the doctors in the practice are actually aware of this shadiness going on, then shame on them. It's one thing if it actually makes the visit take longer or they have to do extra work. 60 seconds of talking that you would have done anyway is just a scam.

Of course they know. Private equity bosses give doctors quotas.

Well not me. I'm now bringing it up at the beginning of every well visit and letting them know I do not wish to discuss anything that will trigger a bill. If enough people do this, it will stop. The entire point of ACA mandating free preventative health care is so that people will actually GET preventative health care. This nonsense is going to achieve the exact opposite of that. It took me forever to find a non-shady dentist too. I will go on another PCP quest if need be.

[Anonymous]

I have a chronic issue that requires medication but no maintenance from the doctor. I used to get refills without a problem as part of my wellness visit but now they kicked it up to an office visit. It’s definitely annoying. They’ve had electronic records for a decade so I really don’t think it’s that.