Medicare and “Yearly Wellness visits.”   21 comments

I have other posts ready in my head to be set down on paper, like “A Healthy Woman is a Crazy Person,” but this is new and, it seems, more urgent.

Several of us have recently had the same problem. If you are not on medicare, you may still want to know this for friends and family who are.

Recently on the notice from my physician to go in for my annual checkup, I ended up getting a Medicare rejection for the $343,00 they will be billing me. Many phone calls later, to many people, I have established the following “facts.” As far as I can tell, this is a new (and personally expensive) ruing.

When I called the medicare number, I was greeted with the cheerful announcement that we are now entitled to a yearly wellness visit. Here’s what that means. (Please do your own explorations to double check what I’m telling you here) And who knows, maybe it varies from state to state.

As my source said, the yearly wellness visit is like a hands free car wash. It is a no hands on interview with your doctor who will ask a series of questions like, “Are you able to dress yourself?” (Honest, that’s what she said.) The doctor is not to touch you or measure anything like blood pressure. It’s all talk, and an opportunity to renew your prescriptions.

If she listens to your heart and lungs and takes height, weight, and temperature, you are then billed for a physical which, as indicated above, is very expensive.

I don’t blame the doctor. She doesn’t have to keep up with the latest medicare ruling. She reports what she did, and someone else does the coding. But do beware.

If, on the other hand, you have a headache, or something specific, you can schedule an office visit and she can test you for things that might be related to a headache, but don’t add more stuff that might get it coded as a physical.

Oh yes, you can get one complete physical when you first turn 65. That will be reimbursed.

The next piece is my supplementary insurance which piggy backs on medicare, so they will not reimburse any of the bill either.

So, I’m paying $343.00 to do things most of which I could have done myself – measure hight, weight, temperature, BP. I suppose the good thing is she could prescribe tests, including mammogram, bone density test, and a number of blood tests. I haven’t received word yet, but apparently they are covered.

And, of course, you can’t have the latter tests if they aren’t prescribed by the physician, so I guess I will be paying $343.00 for the piece of paper that goes to the lab so I can have those tests done.

I’ve had a nice relationship with my physician, but I guess I won’t be seeing much more of her. How will I get the bone density test? I guess I have to schedule an office visit to tell her my bones feel like they are getting holes in them.

Am I confused? Yes, and not at all happy with the situation. Fortunately I can afford to pay the bill when it comes, though I will work out a payment plan so they won’t get it all at once.

The people I’m really concerned about are those who can’t afford such a sum. They will get to see a physician only when they are sick. Never mind staying well.

To summarize

When you turn 65 and go on medicare, you can have a thorough physical which will be covered.

After that, you can schedule “office visits” for particular problems. They will probably be covered.

Otherwise, you are entitled to a “yearly wellness visit” which is a hands-off series of questions.

And check your supplemental insurance to see if it will cover annual physicals without pigging backing on Medicare. It will cost you an additional premium.

I’ll be happy to see comments — maybe contributing additional information



21 responses to “Medicare and “Yearly Wellness visits.”

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  1. The powers that be have the nerve to call a hands-off visit to a doctor a “wellness visit”???? Seriously? OMG. That is ridiculous. You should be able to “phone it in,” then, without charge.

    • That’s about how I feel. I realized that I need to have the “wellness” visit if I want a bone density exam, for example. Confusing? Yes. My friend in Maine said her physician explained to her twice that Medicare had changed its rules. I wonder if my physician,or her practice, should have explained to me. Well, yes, they should have, but I wonder if they had a legal obligation to do that?

  2. Very good information. I am on medicare disability for my diabetis and so far everything is pretty much covered

  3. Whew, this is scary. I’m not on medicare, but this all sounds really unfair and confusing.

  4. this sucks – oh wow – healthcare in the US needs help.

    • Oh my! Does it ever! (Take a look at Leelotchka’s comment.) How about a single payer plan geared toward the health of the populace rather than the wealth of the insurance industry. (Don’t misunderstand me. I wouldn’t repeal Obamacare — a step in the right direction, but we need more steps focused on the goal of the “common welfare.”)

  5. I am just breathing very very relieved at living in Norway, and sending you a hug,Mona

  6. It sounds as if Medicare in Australia is vastly different to yours. Our medicare is all about getting a percentage back from our doctor’s visits or if your doctor is a bulk-biller, then you pay nothing and they only take what the medicare rebate is as payment. We pay a medicare levy as part of our taxes. However, i still try not to go to the doctor that often anyway although the last couple of visits (full health checks) she covered completely with medicare. My blood tests are covered by medicare and also my optometrist visits. Thank goodness.

  7. I’m posting this e-mail from a friend in Maine, keeping her name anonymous since she sent it directly to me. But I find it interesting.
    “I just had a thought on the topic of your blog. When I last had a physical in January, as I recall I was given a written notice that certain charges were not covered by Medicare. Later, when in the dr’s office, she repeated the same info verbally. I recall saying that I my case, it was not a concern because my secondary insurance covered an annual physical. Do you think such a notification is required? And your dr. did not meet this requirement? Of course it’s stupid for Medicare not to cover as a preventive measure.”

  8. 🙂 come to France, Miss Mona: we’ve had THE best medical care in the world for several decades… I’m serious! During our 5 years spent in Houston, TX, we did realize and figure out why so many Americans didn’t have it… just one example: we would pay 50$ for a 5′-visit(consultation), I would send the papers to France and we would be totally reimbursed about 2 weeks later… French people, each and every person who lives and works LEGALLY in France gets “medicare” automatically, paying monthly a proportional amount of money of his salary… it’s longer to explain, but we know that the US health system is a nightmare for lots of Americans, alas!

  9. yikes! I have a few years before I can get Medicare, but appreciate the heads up. I will be careful to ask about whether something is covered before I get it done. I hope they can tell me in advance.

    • They apparently did understand it in Maine where they warned my friend in advance. I don’t know if they just didn’t “know” here in Minnesota or what, but they certainly did not warn me — and the others who found themselves in the same boat. More important, I’m happy if this saves you some trouble when you get to “that age.” (Remember, at least as it stands now, you are entitled to a full physical when you first turn 65.)

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