Dear Dr. Roach: Our excellent insurance allows for a yearly wellness visit at no cost. My regular copay is a very reasonable $10. So, the cost is not the real issue. For the past few years, after my visit, I have received a bill for $10, with the explanation that while the wellness visit was free, I was being charged for a regular visit also. This is because we discussed my blood pressure, which is a preexisting condition. It seems that should be part of my wellness discussion.
The billing office says Medicare Advantage programs allow for this (double?) billing, based on how the doctor codes the exam. Interestingly, my wife, who sees another doctor in the same practice, has never been billed in this manner, even though her doctor has discussed preexisting conditions.
I have a good relationship with my doctor, but have not discussed this with him to any real degree. I guess that I don’t want to rock the boat. But this just seems wrong. Or, if it is permissible, then it seems like a contributor to runaway health costs. I’ve used the word unethical with the billing staff and supervisor. They say it’s not. Am I overreacting? — Anon.
Answer: The annual wellness exam is intended to allow you and your doctor time to discuss strategies for keeping you healthy. It may include performing or scheduling screening tests, discussing physical activity and diet, and other interventions to help reduce injury and disease. The annual wellness exam is NOT a regular visit to discuss problems and do a physical exam.
Some physicians will, in addition to the wellness visit, also do a brief regular visit, such as monitoring and discussing blood pressure. In that case, an additional charge for a “problem-based visit” is allowed. It is neither illegal nor unethical to bill the insurance for both types of services if both are provided. That’s what your physician has done, assuming he did the wellness visit appropriately. However, discussion with my colleagues has shown me that many will NOT bill the insurance for the problem-based part of the visit, as many of their patients don’t understand this issue and the doctors don’t want to upset their patients. It sounds like your wife’s doctor is in that camp.
People without your excellent insurance have to pay a much larger fee, and I can understand why they might be upset, as the nature of the annual wellness visit is often not well explained.
