Annual Wellness Visit

1moretimeagain

1moretimeagain

Inconceivable Member
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These people get on my nerves.

For me and I’m sure many others, the annual wellness visit is the one thing insurance pays for 100% without having met a deductible. In your opinion, should the visit include renewal of existing long-term medications?

I get the concept that a prescription renewal is in itself a follow-up on a previously diagnosed condition , but if there is no discussion and no changes, it seems like we could include that in the visit that insurance pays for.

Also, if the doctor puts something in the lab work order that isn’t included as part of a wellness visit, wasn’t requested by the customer, and wasn’t offered as a separate add-on, I really don’t want to see a bill for it.

Thank you for your attention to this matter.
 
Batt Boy said:
Yep, just had mine. Lapcorp bill was $1850? It was negotiated down to $345 by my payor, and I owed $21. Our system is broken.
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Imagine ordering a $23 entree from a restaurant, receiving a bill for $31 and having the discrepancy explained as “Even though it wasn’t mentioned beforehand and you didn’t request it, we added saffron to the dish which increased your bill.”
 
1moretimeagain said:
In your opinion, should the visit include renewal of existing long-term medications?

I get the concept that a prescription renewal is in itself a follow-up on a previously diagnosed condition , but if there is no discussion and no changes, it seems like we could include that in the visit that insurance pays for.
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Not sure what you are asking here. Are you asking being charged for the doctor writing/renewing the prescription? Or are you asking about paying for the next batch of that prescription? If the former, I have never once in 40 plus years been charged by a doctor for writing a prescription or by a doctor when my pharmacy has to get a refill order from him.
 
uncsig said:
Not sure what you are asking here. Are you asking being charged for the doctor writing/renewing the prescription? Or are you asking about paying for the next batch of that prescription? If the former, I have never once in 40 plus years been charged by a doctor for writing a prescription or by a doctor when my pharmacy has to get a refill order from him.
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The act of renewing an existing prescription. Prescription is written for 12 months, renewal of prescription happens during annual wellness visit.

Annual wellness visit now becomes something Novant called a sick-well visit and submits claim to insurance company with coding that doesn’t fall under the wellness visit, so it isn’t paid as part of the 100% covered wellness visit.
 
farce© said:
Any time I go to the doctor, I am always asked if I need any Rx renewed. It sounds like Novant made a coding error.
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As you might imagine, BLue Cross Blue Shield told me to talk to Novant and see if they’ll resubmit with different coding. Novant told me to file an appeal with Blue Cross.
 
What’s the benefit of these things? Sounds like some kind of audit that I’d be pretty skeptical of.

If you’re already seeing your doctor and getting annual physicals and other specialist visits if needed, why let someone from your insurance butt in?

My mom just recently had one offered to her by her insurance.
 
duluoz said:
What’s the benefit of these things? Sounds like some kind of audit that I’d be pretty skeptical of.

If you’re already seeing your doctor and getting annual physicals and other specialist visits if needed, why let someone from your insurance butt in?

My mom just recently had one offered to her by her insurance.
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The insurer is the party that pays the in-network (Novant) service provider for the wellness visit.
 
1moretimeagain said:
The act of renewing an existing prescription. Prescription is written for 12 months, renewal of prescription happens during annual wellness visit.

Annual wellness visit now becomes something Novant called a sick-well visit and submits claim to insurance company with coding that doesn’t fall under the wellness visit, so it isn’t paid as part of the 100% covered wellness visit.
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Again...I've never been charged for a doctor writing or renewing a prescription. Whether as part of a wellness or any other kind of visit. Guessing that's why I still don't understand the issue.
 
Having been self employed for the last 40 years getting old enough for my Medicare advantage has been a blessing. I had my first colonoscopy at 65 and the doctors said that usually folks do it sooner. I asked them how much did they think it costs and they said that they had no clue! I told them my insurance was $10-15.000 deductible until I turned 65 and it was basically catastrophic insurance. So I’m thinking that since we boomer’s have made shelter/health/education profit centers who’re we gonna blame for the shit show in all three categories? Sound like you are bitching about a first world problem. Not to belittle your complaint but come on man!
 
As a PCP i have a unique experience with these and I think some places border on fraud with this stuff.
The Medicare Wellness visit is covered. It is essentially just that list of questions you are asked (The Health Risk Assessment-HRA) Once you get outside of those parameters, the doctor can and is likely being strongly encouraged to double bill. So if your meds are refilled that is technically addressing issues and lead to the “Evaluation and Management charge- or a like a sick visit 99214 bill”
I basically never double bill medicare wellness visits unless we’re truly getting outside of the scope of the visit and i’m doing actual problem management but I usually get chastised on the back end for this but it keeps my conscious clearer and my patients happier
I quit an organization that was really pushing this. Basically calling patients who needed “care gaps” closed even if they had no reason to be seen, forcing them into AWVs, telling the patient the visit was covered, and then asking us to address all their issues and double bill them. It was gross. The system sucks, is a mess, and i hate practicing medicine in the US
 
uncjhodges said:
As a PCP i have a unique experience with these and I think some places border on fraud with this stuff.
The Medicare Wellness visit is covered. It is essentially just that list of questions you are asked (The Health Risk Assessment-HRA) Once you get outside of those parameters, the doctor can and is likely being strongly encouraged to double bill. So if your meds are refilled that is technically addressing issues and lead to the “Evaluation and Management charge- or a like a sick visit 99214 bill”
I basically never double bill medicare wellness visits unless we’re truly getting outside of the scope of the visit and i’m doing actual problem management but I usually get chastised on the back end for this but it keeps my conscious clearer and my patients happier
I quit an organization that was really pushing this. Basically calling patients who needed “care gaps” closed even if they had no reason to be seen, forcing them into AWVs, telling the patient the visit was covered, and then asking us to address all their issues and double bill them. It was gross. The system sucks, is a mess, and i hate practicing medicine in the US
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This is what I’m getting at.

I understand that it’s presented as “free.” But if you’re already covered and routinely seeing your own PCP, what’s the actual benefit of a visit like this? A second opinion? Doesn’t sound worth it in most cases.

Sounds like some kind of weird hidden audit or billing opportunity. I’m not understanding why anyone with an existing PCP would submit to this.
 
duluoz said:
This is what I’m getting at.

I understand that it’s presented as “free.” But if you’re already covered and routinely seeing your own PCP, what’s the actual benefit of a visit like this? A second opinion? Doesn’t sound worth it in most cases.

Sounds like some kind of weird hidden audit or billing opportunity. I’m not understanding why anyone with an existing PCP would submit to this.
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The doctor was my PCP and I consider the annual wellness visit as my routine visit. My prescription is written for a 12 month period, after that they make me go in to get a new 12 month prescription. I’d like to do that as part of the AWV since insurance covers that visit, but I end up still being billed due to the way the visit gets coded.
 
Have been fortunate thus far with my PCP and insurance with my yearly physical. I request bloodwork test/s that aren’t considered routine and my PCP sets them up along with my routine bloodwork. He tells me each time they might not be covered by insurance but so far they have been. Kind of curious with the changes around healthcare/health insurance premiums and coverage if they will be covered again this year. Keeping fingers crossed.
 
When I need a prescription refiilled, I just go onto the website of what every doctor originally wrote the prescription and leave a message asking for the refill. Typically, I receive a message from his or her nurse within 10 mimutes saying the script re-fill has been sent to the drugstore I designated. Then I can usually pick the refill up within 60 minutes. Pretty painless and quick. My wife, OTOH, follows a MUCH more convoluted and "hands-on" approach for refilling prescriptions.
 
I hadn't been to a primary care doc in 10 yrs, and needed something like a check-up. I'd moved so needed a new doc. I called a practice i'd been referred to and just to get the "physical" where they review my bloodwork, I need an introductory dr visit. Screw that, so i called a different place... same thing :(
So three trips were required: 1 to say hi, another for the blood draw, a 3rd for them to review the results. Seems like #1 was a bit wasteful...
 
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