I am very careful about checking on the Medicare site to see what tests and procedures I'm eligible for. Last November I noticed I was due for an Annual Wellness Exam, and so I scheduled it. I specifically told the office to make sure it was scheduled as a Wellness Visit, so that there would be no problem with payment.
The Annual Wellness visit is an attempt at preventative medicine. The purpose of this visit is to sit down with your physician and evaluate your medical history, your current health status and what medications you are taking. The physician is supposed to check your blood pressure, vision, weight and height, make sure you're current with all your preventative screenings (shots, colonoscopy...). Further tests may then be ordered depending on what the physician determines from this evaluation. (For some reason, Medicare doesn't pay for a complete annual physical. However, I don't think that many doctors are aware of the difference, and incorrectly carry out a complete physical, then bill Medicare incorrectly.)
When I arrived for the Wellness Visit, one of the nurses weighed me, gave me an eye exam, took my blood pressure and gave me a hearing test. I of course assumed that this was part of the Wellness Exam, and that nothing being done was extra. The doctor then carried out a brief physical, talked to me about my health in general, and that was the end of the visit. The visit took probably about 15-20 minutes.
Imagine my surprise when I got a bill for $70.00 six months later. The office had billed Medicare $160.00 for the Wellness Exam, $45.00 for the hearing test, and $25.00 for the eye exam. Medicare would not pay for the hearing test and eye exam that was being billed on top of the Wellness Exam. I wouldn't expect them to - the eye test should have been covered under the $160.00 that they got from the Wellness Exam itself, and the hearing test probably should never have been done at all.
Now it is up to me to fight this bill, and spend possibly hours trying to get things straight. I have already made six phone calls to the billing department and the doctor's office, arguing that the $70.00 charge should be dropped. The doctor's office has told me that they don't know what insurance providers cover, that they just go ahead and do a regular physical, and that they are billing the way that they were taught. They claim that it is not up to them to know what's covered by each patient's insurance. I tried to explain to them that the Wellness Exam is not a regular physical, and that they should know what's covered so that their patients don't incur unexpected costs, but I got nowhere with that. I also argued that they are actually double billing for the eye exam, and that the ear exam was something that I never asked for, and that if it wasn't covered they shouldn't have done it. Again, I got nowhere.
My point to all of this is that in order to bring down costs, the medical providers should know what is covered by Medicare. It may be difficult to figure out what procedures are covered by other providers, but in the case of Medicare, it's pretty straight forward. I believe that there's software to assist the medical establishment with such issues. Whenever they are going to do anything that will not be covered, they should specifically ask the patient before they carry out a procedure. Certainly if I had been asked if they should do the ear exam for $45.00 I would have given them a resounding NO!
