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

[Anonymous]

I'm the OP. So far I've been successful getting the charges removed. I will be proceeding with disclaimers at each visit from now on. The first time that doesn't work, I will be voting with my feet and stating why.

[Anonymous]

Anonymous wrote:

Anonymous wrote:A free preventative care visit (or a “checkup”) is for the appropriate health screenings ONLY. If you have other concerns, you are likely going to pay your copay. It’s not new or a scam, except to the extent that the entire system is a scam.

What are those screenings? The PCP isn't going to do a mammogram or a colonoscopy or a pap smear or a proper skin check or a cardiac assessment or an eye exam or vaccinations. Mine just checks off on the computer that I've had these things done by other specialists or providers. I only turn up because the system pretends this person coordinates my care and because I have to write the name of a PCP on forms. Maybe it's more useful for someone else not already seeing a team of specialists.

PCP can/should be able to offer most exam components of preventive care ( pap, breast exam, heart/lung, vitals, periodic bloodwork), all the screening questionnaires that are considered part of routine screening, and referral for colonoscopy. That IS what the PCV is, it’s what is required to be covered as a no co-pay visit. All those other things you may be used to talking about are not covered preventive care so either need a separate appointment on another day or an office visit/problrm visit added on to the PCV.
As a health care provider this is why I don’t do a “annual exam” with my PCP. I know what is due and when, and that if I am not due for any particular screenings that year he’s just going to ask me a bunch of questions, listen to my heart, and send me on my way.
Here’s how to reframe it in your mind - the covered preventive care we’ll visit had a predetermined set of covered services ( so practitioner directed), anything outside of those is a problem visit/office visit and more patient directed.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A free preventative care visit (or a “checkup”) is for the appropriate health screenings ONLY. If you have other concerns, you are likely going to pay your copay. It’s not new or a scam, except to the extent that the entire system is a scam.

What are those screenings? The PCP isn't going to do a mammogram or a colonoscopy or a pap smear or a proper skin check or a cardiac assessment or an eye exam or vaccinations. Mine just checks off on the computer that I've had these things done by other specialists or providers. I only turn up because the system pretends this person coordinates my care and because I have to write the name of a PCP on forms. Maybe it's more useful for someone else not already seeing a team of specialists.

PCP can/should be able to offer most exam components of preventive care ( pap, breast exam, heart/lung, vitals, periodic bloodwork), all the screening questionnaires that are considered part of routine screening, and referral for colonoscopy. That IS what the PCV is, it’s what is required to be covered as a no co-pay visit. All those other things you may be used to talking about are not covered preventive care so either need a separate appointment on another day or an office visit/problrm visit added on to the PCV.
As a health care provider this is why I don’t do a “annual exam” with my PCP. I know what is due and when, and that if I am not due for any particular screenings that year he’s just going to ask me a bunch of questions, listen to my heart, and send me on my way.
Here’s how to reframe it in your mind - the covered preventive care we’ll visit had a predetermined set of covered services ( so practitioner directed), anything outside of those is a problem visit/office visit and more patient directed.

I turn up once a year because the PCP has to prescribe one medication. Everything else is done my specialists.

I do a pcv visit because I haven't got any other reason to turn up to see them. The blood work is a waste because I get that done several times a year by others anyway. The PCP won't actually do any well woman checks.

[Anonymous]

I had to pay for 2 appointments for a CT scan because I was getting both my chest and pelvis scanned. Even though it was one injection of contrast and less than 4 minutes on the scanner for BOTH combined, I had to pay TWO $50 co-pays, like I came to radiology on 2 different days for each scan.

[Anonymous]

It’s annoying bc the preventive is supposed to be a vitals check, bloodwork, and short interview so they can FIND stuff that you don’t know.

Keep the initial visit free. Let follow up visits charge.

[Anonymous]

Anonymous wrote:It’s annoying bc the preventive is supposed to be a vitals check, bloodwork, and short interview so they can FIND stuff that you don’t know.

Keep the initial visit free. Let follow up visits charge.

In addition, most of us Americans aren’t healthy. They **should** be finding stuff, even minor (that they’ll now charge for) to help us get healthier.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It’s annoying bc the preventive is supposed to be a vitals check, bloodwork, and short interview so they can FIND stuff that you don’t know.

Keep the initial visit free. Let follow up visits charge.

In addition, most of us Americans aren’t healthy. They **should** be finding stuff, even minor (that they’ll now charge for) to help us get healthier.

In reality, the more prevalent this absurd billing practice gets, the more they are just going to drive (especially adults) away from preventative care altogether.

[Anonymous]

Anonymous wrote:

Anonymous wrote:MD here. It’s a billing thing. Our emr pulls from our notes so if we document it- you’ll be charged. If you truly want a free visit - do not bring anything up and just focus on your general preventative stuff but honestly it’s so hard to get a doctor’s appointment, I’d just pay the bill. In my own life, I suck it up and pay my own pcp so I understand this also from a patient’s perspective, Also it’s a bit frustrating for people to blame the doctors for this, esp primary care doctors who don’t make much and we need more of. Talk to your legislators about free health care for all. Don’t blame someone for doing their job, billing appropriately for the work they’ve done and just trying to make a living after years of training and debt.

So you should just stand there in a starfish position and say nothing? What is the purpose of this visit? Please define "general preventative stuff".

Like focusing on general health and scheduling mammograms, colonoscopies and basics lab work. Anything else would be outside of that.

[Anonymous]

Anonymous wrote:

Anonymous wrote:MD here. It’s a billing thing. Our emr pulls from our notes so if we document it- you’ll be charged. If you truly want a free visit - do not bring anything up and just focus on your general preventative stuff but honestly it’s so hard to get a doctor’s appointment, I’d just pay the bill. In my own life, I suck it up and pay my own pcp so I understand this also from a patient’s perspective, Also it’s a bit frustrating for people to blame the doctors for this, esp primary care doctors who don’t make much and we need more of. Talk to your legislators about free health care for all. Don’t blame someone for doing their job, billing appropriately for the work they’ve done and just trying to make a living after years of training and debt.

So you should just stand there in a starfish position and say nothing? What is the purpose of this visit? Please define "general preventative stuff".

Preventative care equals screenings. The kinds of tests that are out there to pick up problems early before people know they are an issue. There’s plenty of great info out there to help you understand what that means. Start here. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations

[Anonymous]

Anonymous wrote:

Anonymous wrote:A free preventative care visit (or a “checkup”) is for the appropriate health screenings ONLY. If you have other concerns, you are likely going to pay your copay. It’s not new or a scam, except to the extent that the entire system is a scam.

What are those screenings? The PCP isn't going to do a mammogram or a colonoscopy or a pap smear or a proper skin check or a cardiac assessment or an eye exam or vaccinations. Mine just checks off on the computer that I've had these things done by other specialists or providers. I only turn up because the system pretends this person coordinates my care and because I have to write the name of a PCP on forms. Maybe it's more useful for someone else not already seeing a team of specialists.

They write the orders for screening mammograms and colonoscopies.

They absolutely do administer the CDC-recommended vaccines for your age. They are supposed to screen for depression.

They take vitals and run the labwork recommended as SOC. (It may be quite a bit less labwork than you think, esp if you are an otherwise healthy person who wants “basic labs every year.”) The actual frequency and complexity increases with age.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:MD here. It’s a billing thing. Our emr pulls from our notes so if we document it- you’ll be charged. If you truly want a free visit - do not bring anything up and just focus on your general preventative stuff but honestly it’s so hard to get a doctor’s appointment, I’d just pay the bill. In my own life, I suck it up and pay my own pcp so I understand this also from a patient’s perspective, Also it’s a bit frustrating for people to blame the doctors for this, esp primary care doctors who don’t make much and we need more of. Talk to your legislators about free health care for all. Don’t blame someone for doing their job, billing appropriately for the work they’ve done and just trying to make a living after years of training and debt.

So you should just stand there in a starfish position and say nothing? What is the purpose of this visit? Please define "general preventative stuff".

Like focusing on general health and scheduling mammograms, colonoscopies and basics lab work. Anything else would be outside of that.

Refills for pre-existing issues that are stable and do not require additional care or discussion should also be included. This is what they got me on last year. I fought it (hard) and eventually won, but they tried to say it was because I "discussed" my issue with the doc. I didn't. He said, "do you need refills of X?" and I said, "Yes, thank you." That was the entire "discussion."

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:MD here. It’s a billing thing. Our emr pulls from our notes so if we document it- you’ll be charged. If you truly want a free visit - do not bring anything up and just focus on your general preventative stuff but honestly it’s so hard to get a doctor’s appointment, I’d just pay the bill. In my own life, I suck it up and pay my own pcp so I understand this also from a patient’s perspective, Also it’s a bit frustrating for people to blame the doctors for this, esp primary care doctors who don’t make much and we need more of. Talk to your legislators about free health care for all. Don’t blame someone for doing their job, billing appropriately for the work they’ve done and just trying to make a living after years of training and debt.

So you should just stand there in a starfish position and say nothing? What is the purpose of this visit? Please define "general preventative stuff".

Preventative care equals screenings. The kinds of tests that are out there to pick up problems early before people know they are an issue. There’s plenty of great info out there to help you understand what that means. Start here. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations

So you shouldn't mention chest pain, headaches or gastro symptoms that might actually indicate cardiac issues or cancer. You shouldn't say you get out of breath going up the stairs. What kind of preventative care is that? How did doctors work in the 1950s when they didn't have this technology? Presumably they talked to the patient and asked questions.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A free preventative care visit (or a “checkup”) is for the appropriate health screenings ONLY. If you have other concerns, you are likely going to pay your copay. It’s not new or a scam, except to the extent that the entire system is a scam.

What are those screenings? The PCP isn't going to do a mammogram or a colonoscopy or a pap smear or a proper skin check or a cardiac assessment or an eye exam or vaccinations. Mine just checks off on the computer that I've had these things done by other specialists or providers. I only turn up because the system pretends this person coordinates my care and because I have to write the name of a PCP on forms. Maybe it's more useful for someone else not already seeing a team of specialists.

They write the orders for screening mammograms and colonoscopies.

They absolutely do administer the CDC-recommended vaccines for your age. They are supposed to screen for depression.

They take vitals and run the labwork recommended as SOC. (It may be quite a bit less labwork than you think, esp if you are an otherwise healthy person who wants “basic labs every year.”) The actual frequency and complexity increases with age.

How can they screen for depression? As soon as you answer the question they'll slap an extra charge on you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:MD here. It’s a billing thing. Our emr pulls from our notes so if we document it- you’ll be charged. If you truly want a free visit - do not bring anything up and just focus on your general preventative stuff but honestly it’s so hard to get a doctor’s appointment, I’d just pay the bill. In my own life, I suck it up and pay my own pcp so I understand this also from a patient’s perspective, Also it’s a bit frustrating for people to blame the doctors for this, esp primary care doctors who don’t make much and we need more of. Talk to your legislators about free health care for all. Don’t blame someone for doing their job, billing appropriately for the work they’ve done and just trying to make a living after years of training and debt.

So you should just stand there in a starfish position and say nothing? What is the purpose of this visit? Please define "general preventative stuff".

Preventative care equals screenings. The kinds of tests that are out there to pick up problems early before people know they are an issue. There’s plenty of great info out there to help you understand what that means. Start here. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations

So you shouldn't mention chest pain, headaches or gastro symptoms that might actually indicate cardiac issues or cancer. You shouldn't say you get out of breath going up the stairs. What kind of preventative care is that? How did doctors work in the 1950s when they didn't have this technology? Presumably they talked to the patient and asked questions.

In the 1950s, for the most part, patients paid doctors directly and on-site. If you are going to allow a copay to dictate whether you mention chest pain to your doctor, you have problems that need a specialist outside of primary care.

Or: sorry about your HDHP, but this is what the HSA dollars are for.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:MD here. It’s a billing thing. Our emr pulls from our notes so if we document it- you’ll be charged. If you truly want a free visit - do not bring anything up and just focus on your general preventative stuff but honestly it’s so hard to get a doctor’s appointment, I’d just pay the bill. In my own life, I suck it up and pay my own pcp so I understand this also from a patient’s perspective, Also it’s a bit frustrating for people to blame the doctors for this, esp primary care doctors who don’t make much and we need more of. Talk to your legislators about free health care for all. Don’t blame someone for doing their job, billing appropriately for the work they’ve done and just trying to make a living after years of training and debt.

So you should just stand there in a starfish position and say nothing? What is the purpose of this visit? Please define "general preventative stuff".

Preventative care equals screenings. The kinds of tests that are out there to pick up problems early before people know they are an issue. There’s plenty of great info out there to help you understand what that means. Start here. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations

So you shouldn't mention chest pain, headaches or gastro symptoms that might actually indicate cardiac issues or cancer. You shouldn't say you get out of breath going up the stairs. What kind of preventative care is that? How did doctors work in the 1950s when they didn't have this technology? Presumably they talked to the patient and asked questions.

Of course you should, but those all require diagnostic work up ( additional eval to figure out a problem) which is different than preventative care ( screening to detect potential future problems and prevent from becoming a problem). Those you get billed for.