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About those ‘free’ checkups …

By Jay MacDonald ·
Tuesday, March 25, 2014
Posted: 6 am ET

Karen Garloch found something she really didn't expect on her first "free" wellness visit with her doctor: a bill.

"It happened to me in 2012 when I saw my family doctor for an every-other-year checkup," she writes in The Charlotte Observer. "My insurance paid $256, the total for the preventive exam. But the 'explanation of benefits' showed that I also owed $74.60, my share of the $113 bill for an 'office visit' -- on the same day, in the same time slot."

What the heck? After all, beginning in 2011, the Affordable Care Act required health insurance companies to offer free annual wellness visits to some 54 million Americans with private health plans. Obamacare also provides a free annual checkup to 32.5 million seniors on Medicare.

1 office visit, but 2 billings

When Garloch inquired about the unexpected bill, she learned that her warm-fuzzy wellness visit should have come with a caveat.

"(My doctor) explained the second charge resulted from our talk about my elevated cholesterol level, which had been diagnosed previously. Because he documented that discussion and marked the billing code for evaluation and management of a cholesterol diagnosis, I was billed for the second visit," she writes. "I have learned since that it's not unusual to get this extra charge with a preventive exam."

Garloch says several factors may have helped generate that additional bill.

Just following the rules?

For example, some insurers have tightened up what constitutes a gratis wellness visit to more closely adhere to the Affordable Care Act. Physicians are under increased pressure to document each service they provide, partly because of new Medicare reimbursement criteria. And the growing number of high-deductible health plans may prompt patients to save up their health questions for their free annual exam to avoid paying extra for separate visits.

"Because this is confusing to patients, some doctors have begun sending notices in advance, letting patients know they could be charged extra if they bring up questions that aren't considered part of a preventive exam," she says.

Consider yourself warned.

Do you think it's fair that you could be billed for a "free" exam?

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March 27, 2014 at 10:35 pm

I work in the medical field. Doctors do not set the rates they bill you, the insurance companies do and it is based on "reasonable and customary" rates. The doctors and other providers are in medicine because they want to help people, sometimes that takes a little longer than others because some people need more attention. If you don't feel you should have been billed for a service, then talk to the clinic and/or your insurance company about it. One of the reasons for the upgrade to the ICD-10 diagnosis codes are for more specific documentation about what you and the provider discussed in order to provide you with better healthcare service.

Daisy H.
March 27, 2014 at 9:03 pm

Thirty years ago I was charged $24.00 for a steri-strip, which was the band-aid they put on my arm after a blood draw. You could've bought a gross of them for that I'm sure. There is no reliable system to take these complaints seriously and moderate/mediate/manage the behavior of these egos. I do believe a lot of Dr's and medical personnel work hard and do care but money and power corrupts. We have to use our power to choose legislators and Dr.s that work for the people. Even though, people at times

March 27, 2014 at 8:56 pm

I actually see my P.A. instead, the doc's in my office do not listen. When my husband goes into the Doctor he is listened to and is treated with respect.....I find that most times females get the short end and are treated as if they are there to waste time. Also, when you have to wait for more than 15 minutes past your appointment why are we not compensated for the incovenience and time lost?

Harold Stanon
March 27, 2014 at 7:43 pm

Most of my experience with doctors and the health care system has been very poor. These people are nothing but money grubbers and the health care system operates similar to the mafia-- they would make Tony Soprano blush. Like the mafia they operate in secrecy. Like the mafia they commit criminal acts on a regular basis-- falsify records; bill for services they don't perform; poor quality with no fear of reprisals; blaming the patients for their incompetence.

March 27, 2014 at 7:26 pm

The medical field is corrupt, and so are insurance companies. you are actually paying to get sicker and to stay sick. I am a firm believer in homeopathic remedies due to the fact that every time I went to the doctor and got prescribed medication I would constantly get side effects from it and have to be seen again. And of course pay more money. Doctors want people to get sick or become injured because that is how they make their money and they make sure to charge you for every minute of it.

March 27, 2014 at 7:15 pm

@John.. The lil' darlings have a scam for that too:)) You may notice that most of these scamm..err 'Doctors- now post on their walls that if you give anything less than 24 hours notice to cancel.. They will bill the 5hit out of you for that too:(
These doctors expect to pay their education loans off in 6 months & retire by the end of the year..
MOST of us when we need more mulah.. we MUST work more hours or take on more jobs.. Not so with the prima donnas we have as doctors today:(

March 27, 2014 at 7:08 pm

I had a doctor milk my insurance for 2 weeks while I got sicker & sicker. I told her that I didnt feel as if I was getting better & REALLY needed to get back to work. She said' Fine! GO BACK TO WORK!.. I went back to work for a day & a half & had to be taken to the ER. THEY wanted to hospitalize me:( The ONLY conclusion I could come to was she didnt believe I was sick & just pumped the insurance for what she could get. OR......
Since these doctors can just make up 5hit & send out bills, they probably have a hard time with the concept of MOST of us MUST go to work & do SOMETHING to get a paycheck..

March 27, 2014 at 6:04 pm

My doctors office has three doctors in their practice. On one particular visit, the doctor asked me how I was making out with my effort to quit smoking. I didn't bring up the subject. The EOB listed a charge for smoking cessation consult. I asked not to be examined by her anymore. I'm a plumber, can you imagine the response I would get if I went to do a job at her home and asked how her 10 year old water heater was doing, which wasn't leaking yet, and charged her for asking that question?

Mr Frank Grasha
March 27, 2014 at 5:34 pm

Dr,s & Hospitals today beleive they are there just to provide an income for themselfs The Dr,s reccomend & prescribe whatever they hold stock in . Everything has become a production line Move along little doggie move along . Patients are just a ticket to a opening in a health plan that pays for a certain set of no,s A set amount . The ACA was supposed to help in getting the care needed We will see how that works out .

March 27, 2014 at 5:26 pm

If you make an appointment and show up and find the waiting
room full of people and a TV on then walk right out.