Wellness visits aren’t regular checkups

While many may confuse the two, a wellness visit is not a regular checkup. Wellness exams are intended to all patients to discuss strategies for staying healthy; a full checkup involves a physical examination.



April 28, 2020 - 10:30 AM

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.

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