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Thread: When is a routine exam NOT a routine exam?

  1. #1
    Junior Member
    Join Date
    Jan 2011

    When is a routine exam NOT a routine exam?

    Maybe I'm just confused , but it used to be you would go in and get an annual or every other or every three year exam/checkup. At that time, you download all your history and problems to the doctor.

    You then go get a bunch of lab tests and, if healthy, you are done until the next cycle.

    Well, recently, I go in and they have this notification that a routine exam will be routine "IF YOU DON"T BRING UP ANYTHING OR TELL OR ASK THE DOCTOR ANYTHING." Those questions and such will be coded as a diagnosis/office visit even though you are doing it all in the same visit and the visit takes no longer than usual.

    Umm, to me this doesn't sound like a good practice but a way to get the maximum bucks out of the insurance company at your cost. It's not like a visit to the auto shop where you get a quote and you have to sign off/agree to the increase to fix any subsequent issues after they take a look to see what the problem really is. You don't even get a detailed explanation/billing of what treatment you actually got. All you get is a big bill with a due date of less than two weeks. Like that gives you any time to call during work days during work hours to find out what's up.


  2. #2
    Senior Member herbgeek's Avatar
    Join Date
    Dec 2010
    New England
    From what I understand, the medical coding for routine aka preventative medicine is different from prescriptive aka fixing a problem medicine because they often are reimbursed at different rates.

  3. #3
    Senior Member mtnlaurel's Avatar
    Join Date
    Jan 2011
    that's why I whisper "Medical School, Medical School" in my children's ears as they sleep
    dealing with the modern healthcare system, just the thought of it, makes me tense up

    what about any of that is healing?

    I have no solutions or even ideas, just excited to complain! URGH

    Thanks for bringing up this thread - the 'behind the scenes of medicine' is something I always want to learn more about

  4. #4
    Senior Member
    Join Date
    Dec 2010
    I learned the hard way to be very clear what's a routine/annual exam and what's a visit to discuss a specific complaint. (I complained about the ambiguous billing and they took it off, but still) And I'm forthright with my doctor -- whom I like and trust -- when she asks how I'm doing, even asking, "If I tell you how I am, does that mean this isn't an annual exam covered by my insurance?" The whole thing is so shady, but I've learned to play the game.

  5. #5
    Junior Member mermaid's Avatar
    Join Date
    Jan 2011
    Austin, TX USA
    Agree about it being due to insurance. I stopped seeing my previous doc for this reason -- I really liked her, but she had the thing about not discussing "chronic issues" (like talking about my lab tests/cholesterol issues) and "acute" problems (illness or anything new).

    She was also my girlfriends's doctor. She got sick on a trip, and the most obvious symptom was a UTI. She called and told the receptionist that she had a UTI and needed to come in. They set an appointment, and gave us their sheet where you write what you want to see the doc about.

    GF wrote the issues (including a high fever), and the receptionist told her they could only see her about the one problem. As the nurse was taking her BP, nurse told her they would only treat the UTI and GF said she had several symptoms. Nurse got mad and slammed a clipboard on the exam table and broke it!!

    We left without seeing the doc, made them remove the copay from our card, and never went back. We went to an urgent care and they treated us great for a reasonable price. Horrendous.

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