Archive for the ‘medicare’ Tag

THURSDAY UPDATE: “FIGS … ” AND MEDICARE ADVICE   8 comments

If you haven’t discovered it yet, please note that “Figs & Pomegranates & Special Cheeses” is now available inĀ Kindle edition. And while you’re there, take a look at the new reviews.

About the Medicare advice. This is what I learned based on my recent experience. If you have already had the one physical allowed when you first joined Medicare at 65, don’t ever again use the word “physical” when making an appointment with your doctor because Medicare won’t cover it. You are entitled to the hands off “annual wellness visit” which will give the opportunity for renewal of prescriptions and orders for tests to be done, e.g., mammograms, bone density, etc. Check out your manual for details.

If your secondary insurance, like mine, piggy backs on Medicare, it won’t cover a “physical” either. If you have secondary insurance that will cover it, then you’re all set, I guess.

Check out “Annual Wellness Visit” in your Medicare Manual just to double-check what I’m saying here.

Visits to the doctor for specific illness or symptoms are, as I understand it, covered.

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

 

 

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