Skipping the Yearly Wellness visit?

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Is it true that if you go into the doctor for your "Free" (quote on purpose) yearly wellness visit from Obamacare, that if you discuss any symptom or health problem with the family doctor that it automatically becomes a "disease" visit and it now goes towards your deductible/you are charged?

This seems to be an urban legend floating about out there that at least seems partially grounded in truth but maybe it's a half-truth, not sure.

A few people I know are skipping this idea (ie; skipping the yearly wellness visit) that seems good on paper (investing in prevention).

[ua_guy]

If I had to guess, I'd assume those people are attempting to use a preventative care visit to discuss or receive care for other issues which don't fall under the category of preventative care, and/or the doctor isn't able to code the visit as such.

From Healthcare.gov, here's what's supposed to be covered under a preventative care visit:

https://www.healthcare.gov/preventive-care-benefits/

[disneysteve]

Is it true that if you go into the doctor for your "Free" (quote on purpose) yearly wellness visit from Obamacare, that if you discuss any symptom or health problem with the family doctor that it automatically becomes a "disease" visit and it now goes towards your deductible/you are charged?

If I had to guess, I'd assume those people are attempting to use a preventative care visit to discuss or receive care for other issues which don't fall under the category of preventative care

ua_guy is correct. As that link shows, a wellness visit is a preventative screening. If you go in armed with a list of problems that you want the doctor to address, that isn't a wellness visit. That is a sick visit. You can't ask the doctor to look at the mole on your back, change your BP medicine because the one you're on is making you sleepy, treat you for the ankle you twisted in the gym last night, or give you cream for the rash on your arm. The problem is that many patients figure they'll take care of everything at once, but it doesn't work that way.

What should happen is one of two things. If there are acute problems that require care, the doctor should take care of those and reschedule the well visit. If there are problems that need attention but not immediately, he can do the well visit and schedule a later appointment to address the other issues.

[disneysteve]

A few people I know are skipping this idea (ie; skipping the yearly wellness visit) that seems good on paper (investing in prevention).

I don't understand this part of your post though. What's the point of skipping the wellness visit? Why not go for the covered screenings? While it's true that you can't also be treated for acute illness at the same time, that doesn't lessen the value of the preventative visit.

This is really a huge problem with our medical system. People wait until something is wrong to see their doctor. So many things could be prevented or caught early on if people would go for annual physicals and routine screenings (mammograms, colonoscopies, BP checks, diabetes screens, etc.).

[HappySaver]

Does this apply to "free" annual preventative visits covered by private HMO's? I have an HMO through work, not through the healthcare.gov site.

I have an annual check scheduled in several months. I was hoping to get bloodwork drawn to check my vitamin levels and a few other biomarkers (as a celiac, I'm supposed to have it done every year). This is above and beyond what an "average" person gets done during the annual visit. Am I supposed to schedule a separate visit for that? I've always just had it done during sick visits before, so no prior experience with this.

[Thrif-t]

Yes you are right if you ask a question it becomes a sick visit and you get charged. I made that mistake a few years ago when I went in for a visit asked a question about my neck, didn't need any PT or drugs but we discussed it and I had to pay the office co pay. Whatever i think that was a scam. This year I went in for my well visit after not having went back in 4 years and my doctor looked at me like why are you here? We updated my history since it had been so long and she gave me an order to get my blood drawn for routine screenings. I have nothing wrong with me so I was carefully not to ask any questions this time.ha And I will be looking for another doctor I"m not too crazy about this one I have now.

*edit* to add our personal insurance 4 years ago started letting us get free preventative visits, it didn't have anything to do with Obama Care then.

[creditcardfree]

I think this is sad that insurance coding and billing has to dictate how we discuss our health with our doctor. I'm suppose to take more time on the schedule to discuss some non wellness issue, that might easily be taken care of in the allotted time? I now need to come in two or more times to discuss my health, doesn't seem very patient friendly in my opinion. I guess I have never had this issue come up.

[disneysteve]

As the resident physician here, let me respond to a couple of things.

First off, this has nothing to do with the Affordable Care Act. These rules apply to many insurance plans including Medicare.

As for it being patient unfriendly, you need to look at it from the other side to be fair. Doctors schedule a certain amount of time for a patient depending on the reason for the visit. If, in the middle of a visit, the patient throws in something that wasn't supposed to be part of that visit, the doctor needs to prioritize the issues at hand. There is a waiting room full of patients waiting for their scheduled appointment too.

Just as it isn't appropriate to come for a sick visit and hand the doctor a 4-page physical form "since I'm already here", it is equally not appropriate to come for a physical and hand the doctor a list of complaints and concerns that you'd like to address "since I'm already here." If none of those concerns are urgent, it's perfectly reasonable for the doctor to do the well visit and ask you to return to attend to the other issues. If, however, one or more of those issues is more significant, it is appropriate for the doctor to say, "I'm concerned about those symptoms. Let's reschedule your well visit and take care of that today instead."

[creditcardfree]

What if I schedule an appointment to discuss all the issues, specifically stating what I'm coming in for? I think that is fair. You can bill for a well exam and other issues together. And if you can't do that, I definitely call foul on the insurance companies and doctors for not being patient friendly. I'm actually looking to schedule a well exam soon and also have medication to renew. I don't see why those will need to be seperate appointments.

[disneysteve]

What if I schedule an appointment to discuss all the issues, specifically stating what I'm coming in for? I think that is fair. You can bill for a well exam and other issues together.

Definitely. We do that all the time. If someone comes for a physical but is having a problem, I take care of it as best as I can as time permits.

The problem is specifically with plans that allow for one free wellness exam per year where you don't have to pay your copay. In that case, you can't combine a bunch of other issues in that visit if you still want it to qualify as that free exam.

And just getting a refill on a prescription would be fine in any case, even if it was your free wellness exam. That's different than actually addressing a problem.

[sblatner]

Our 16 year old went in for his physical and I asked the doctor to discuss posture. He billed for a wellness visit which was 100% covered and an office visit for the posture discussion. I'm sure the posture discussion was less than 5 minutes but he billed for it anyways. I would think checking his back would be part of the wellness visit.

[disneysteve]

Our 16 year old went in for his physical and I asked the doctor to discuss posture. He billed for a wellness visit which was 100% covered and an office visit for the posture discussion. I'm sure the posture discussion was less than 5 minutes but he billed for it anyways. I would think checking his back would be part of the wellness visit.

A big part of the problem is confusion over what "wellness visit" actually means. Most people think it's the same as a physical but if you read the link posted above, you'll see that a wellness visit actually involves almost no physical examination. It's mainly supposed to be focused on addressing preventative care measures - disease screenings, counseling on things like smoking cessation and obesity. A thorough wellness exam need not involve any more actual examination than getting your height, weight, and blood pressure.

ETA: However, your 16 year old was probably there for an actual physical, not a wellness visit, and yes, I think a scoliosis screen should be part of that.

[LuckyRobin]

Maybe a wellness visit for a man doesn't include a physical exam, but a wellness visit for a woman includes it. Breast exam every year, pap smear every other year, and my doc always checks eyes, ears, nose, and throat while he's at it. Always asks about new moles or anything like that. Does blood pressure and pulse and checks reflexes and takes weight. Tells me to schedule a mammogram. I don't know how it can be a wellness "exam" if there is no examination.

And of course people try to include other things in the visit. At $170 for a 15 minute visit, you are going to try to get your money's worth. (I have no co-pay, I have to pay up front until we've met a $5000 family deductible). If it weren't so ridiculously expensive to see a doctor, we might be more inclined to schedule 3 or 4 visits. Five years ago it was $85. Now it's double that. It's hard to swallow that the doctor has to bill separately for every little thing. I get that they do and why they do, it's just hard to swallow.

[feh]

First off, this has nothing to do with the Affordable Care Act. These rules apply to many insurance plans including Medicare.

+1

This has happened to my wife a couple times, long before the ACA was passed.

Patients (customers) need to be careful about what takes place during a wellness visit, if they don't want it to become a billable event.

[ua_guy]

Coming back to post that I also don't understand why anyone would choose to skip a wellness visit out of fear of asking a question..


I wouldn't think it to be crass or inappropriate in any way to tell your doctor that this just needs to be a wellness visit---if we discuss anything that wouldn't be covered under the visit, please let me know because I don't want to pay / cannot afford / to be billed for a regular office visit right now. It sucks, but this is the healthcare system we've come up with in the last 50 years.