When is a free Medicare visit not a free visit? Or, how did that doctor get a hand in my pocket?

Filed Under: Costs

medicare claims for part B spreadsheet

A friend writes:

Since starting ClearHealthCosts a decade ago, you have seen and heard every story in the book about health care costs. So I know that what I am going to describe to you won’t be new – to you. But it was new to me this fall, and, outraged, I decided to share it with you, just for the heck of it.

I retired in February 2018 and am now receiving Social Security and Medicare. During my lengthy process of preparing to retire and choosing a Medicare supplement plan, I learned something that pleased me: That as a Medicare recipient, I would be entitled to one free physical every year. Sweet!

The first time I called to make an appointment for “my free Medicare physical,” I was informed that it isn’t actually a “physical exam.” No, Medicare — and the health care industry — prefer to call it an “annual wellness exam.”

I soon learned why it’s not called a “physical exam”: because it isn’t that at all, and Medicare and the health care industry certainly want to stave off any legal action concerning the breadth of the procedure. So, “wellness exam” it is.

What it is, and what it isn’t

And it’s virtually worthless. Oh, the doctor may (or may not) check your ears and your nostrils, and may squeeze your ankles, and may have you lie supine on the exam room table to press on your abdomen. But that’s really about all, as far as any “physical” aspect of Medicare’s “free annual wellness exam.”

But I learned something new this year.

My exam was scheduled for a 25-minute block of time on May 12 at the medical center where my primary care physician works. After he entered the exam room, we chatted about the state of my health since my previous visit. We talked about how I should go about losing the weight he advised me to lose. He checked my ankles and my abdomen. And then he sent me on my merry way.

Five months later, I received an EOP from Medicare indicating that I would soon be billed in the amount of $103.28 from my doctor’s office. Huh? I hadn’t been there since … well, since my “Medicare annual wellness exam.” Which is free. Right?

Three component parts

Ah, but here’s how the medical establishment goes about wringing cash out of patients:

It turns out that that 25-minute “free Medicare wellness exam” was broken down into three component parts, for purposes of billing. The doctor’s fee for the “annual wellness exam” was $276.00, and that cost was, in fact, picked up by Medicare. [Medicare paid $109.85.] Great! But the visit also included “face-to-face intensive behavioral therapy for cardiovascular disease, individual.” The charge for that was $63.00. Medicare picked up the cost for that, as well. [Medicare paid $25.21.]

The third component of the visit consisted of “established patient office or other outpatient, visit typically 25 minutes.” And, yeah, that is a bunch of gobbledygook, and the “typically 25 minutes” is misleading because it implies a block of time in addition to rather than including the time spent for the wellness exam. And the charge for this was $207.00. The EOB says Medicare approved a $103.28 charge for that and applied it to my deductible, leaving me with an obligation to pay $103.28 for the “free Medicare wellness exam.”

Granted, $103.28 isn’t a lot, in the grand scheme of things. But I resent how the medical establishment has found a way to soak me for a doctor visit — which supposedly is free to me — by breaking it down into misleading component parts of the 25-minute office visit.

And that’s all I wanted to say!

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medicare claims for part B spreadsheet scaled

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