I got caught in a very common healthcare trap, and it could have cost me over $200.
I went in for my “free” annual exam that health insurance plans must cover as part of Obamacare’s preventive health benefits.
Typically, these exams—also known as Adult Wellness Visits (AWV)—are opportunities for the physician to tick a lot of boxes about your health habits (smoking, drinking, sex, etc.) and schedule you for a bunch of screening exams (mammogram, cholesterol, blood glucose, etc.)
Related post: Annual exams vs. annual wellness visits
For an exam to be covered as preventive, the doctor’s billing office has to code the visit as a “well woman visit” or “annual preventive exam.”
If you bring up a concern that falls outside the somewhat arbitrary definition of “wellness,” you may find yourself billed for an additional office visit at an additional cost.
That’s what happened to me.
The doctors’ new rule: One problem, one visit.
Actually, it’s not really a new rule. Some doctors have always been much more structured in their approach to office visits and prefer that patients make separate appointments for separate problems. Otherwise, it’s difficult to keep control of their schedules.
I respect that.
Other doctors tend to be more loose with their schedules and happy to discuss a laundry list of issues while you’re there.
In today’s healthcare sandbox, however, I see more physicians playing by the one problem, one visit rule. Especially primary care providers, as their corporate overlords are constantly demanding they see more patients and increase revenue.
Like patients, physicians are struggling to find their way through all the changes in healthcare.
I respect that, too.
But if a patient has an expectation that an exam is covered at no charge, it’s only fair they be informed if that is not the case.
An unexpected expense
A few months ago I saw my primary care provider (PCP) for my annual preventive visit. Actually, it was my first time meeting her, and I wanted her to know a little about me, so I had a very short list of things to tell her. I knew I’d have less than 15 minutes, but I was prepared and I kept it short.
I’m a savvy patient, after all.
Not savvy enough, apparently.
I brought up my problem sleeping and we spent a few moments talking about getting a sleep study in the future. That’s all.
So I was really surprised when my Explanation of Benefits (EOB) came and I saw that my insurance had been billed for both the preventive exam ($368) and a regular office visit ($212)!
In my case I only had to pay a $30 co-pay for the extra visit, thanks to good insurance this year. But if I still had my high-deductible health plan, I would have had to pay the entire fee and apply it toward my deductible.
This is a trap many patients are caught in every year, and it can be costly.
What to do if you’re charged an additional visit fee
I get that doctors need to have control over their time and schedules.
But I think it’s rude and unfair if they don’t either
- Courteously explain their standard procedures and ask you to schedule another appointment to discuss that secondary problem; or
- Warn you upfront that if you want to stay and discuss the secondary problem, you will be charged for an additional office visit.
Either way, patients can make an informed decision that works for their time and budget.
If, like me, you are blindsided by what you think is an unfair charge, don’t just accept it. Push back, a little.
- Write a letter or email to your doctor and explain the situation in your words. The doctor has the power to resubmit the charges to your insurance company, or instruct the billing office to do so.
- Attach a copy of the Explanation of Benefits, and circle or highlight the charge you are disputing.
- Emphasize that you were not informed you would be charged for an additional office visit, and you would have acted differently if you had known.
- Follow up with a phone call if you don’t hear back from the physician or the billing office within a reasonable length of time (2 weeks should be long enough).
In my experience, doctors are quick to respond when called out on the question of “informed consent.”
No one has more respect for physicians than I do. However, I want them to respect my time and financial situation, too, and understand that I don’t always know their rules and what they want me to do.
But I’m always willing to learn.
Want to be a more savvy patient? Here are some of my favorite books: