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Thread: Health Insurance - Routine Exam Charges

  1. #1
    Senior Member Cypress's Avatar
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    Health Insurance - Routine Exam Charges

    I had a routine physical exam in November 2014. I received a bill for $15 from UMass Memorial Medical Group on February 11, 2015. I called this office and said it's fully covered service on my Blue Cross Blue Shield insurance plan. There is no co-pay on this service.

    The customer service rep I spoke with was able to look into the notes from the exam and explained that because my DR spoke to me about a preventive care mammogram and how I was doing with migraines, I am being charged for an "office Visit" in that part of the physical exam. She claims it went outside the realm of a preventive covered service.

    I said, stop that nonsense! It's all part of the routine preventive care exam, you cannot dissect the conversation, which is none of anyone's business but mine and the DR, and charge me. She said she'd put the bill on hold and ask for an explanation of charges. Not sure what that is but no way am I paying for this. The customer service rep said this is becoming routine and not out of the norm.

    What the HELL! What the HELL! I rarely see the doctor, only go for regular care and hardly use the system. Why is this being allowed? Why aren't consumers fighting back on this?
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  2. #2
    Moderator Float On's Avatar
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    I'm surprised they didn't add two charges since you talked about two "extra" issues. I had a friend on facebook really upset about her Dr's visit because she got charged 3 visits because they talked about 3 "not even an issue" issue. And the Dr was the one to bring up the 3 issues!
    Float On: My "Happy Place" is on my little kayak in the coves of Table Rock Lake.

  3. #3
    Senior Member kib's Avatar
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    Ah, yet another talking point for avoiding the Dr. until dying anyway. Or maybe even then. Unbelievable.

    My BCBS has a program for which you can receive a small amount of $ for "managing your health". You select an "issue", say, you're feeling very stressed out. They give you some suggestions on how you can manage stress. Then you log in every day for three weeks and say how stressed you are today. The catch: unless you say you had low or no stress, it doesn't count. So basically you log into this site to make $10, but you don't get paid unless you tell them what they want to hear. Possibly the most absurd "health promoting" idea I've ever heard of.

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    Got hit for this for the same reason. I asked about my asthma during my preventive physical (have been on meds for years) and it was $20 please.

  5. #5
    Senior Member Cypress's Avatar
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    My appointment that day was at 1 p.m. I arrived 10 minutes early to find the office locked for the lunch break. I could not even enter the waiting room, I was locked out in the hallway. When the door opened and I went in for the exam, I waited 1/2 hour for the DR. She had been on the phone with a personal medical issue. She was limping and complaining of knee pain. It was almost absurd. I said maybe you should have cancelled me today? She brought up the mammogram and migraine, not me. So, should I bill the DR for bringing up these preventive care moments in the preventive care visit?

    What kind of nit picking is this? It struck me as a scam when it was being explained to me the why of the charge. I will file a complaint with the state on this. I repeat, I rarely, rarely visit the DR. I am fortunate to be fairly healthy and take care of myself. It does make me say, I'll go only if it's a last resort. This stinks!
    Here is a link to my blog page http://francesannwy.wordpress.com/

  6. #6
    Simpler at Fifty
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    It is called upcoding. Drs do it all the time.

  7. #7
    Senior Member Cypress's Avatar
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    So, it's me than that is not up to speed on changes in healthcare because I am a low end user? This is routine? It didn't happen last year during the same preventive exam. This is a new to me.
    Here is a link to my blog page http://francesannwy.wordpress.com/

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    i have a different issue, my school district still contributes the same amount, i still pay the same amount, they just looked better because they cancelled one type of policy and we had few choices besides the one you pay the first $2K and then they start paying a percentage. my total healthcare does not hit $2K a year. then they give you $63 in a health account every month in addition to your contribution. i use that to make a monthly payment against my balance, there is almost no way to avoid debt and monthly management of your health care even if you only go a couple times a year. i have cut my psychiatrist appointments from 2 times a year to one because of this, and if i get sick i have to worry again about if i have enough funds that week, or it just goes onto a running bill, then you pay out of the HSA, then monitor the account, argh. Speaking of that i am going to make my brain DR appointment, why do these appointments take months to schedule?

  9. #9
    Senior Member iris lilies's Avatar
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    I am curious about this, too, but if I regularly visited a dr, I don,t know that I would expect my physician to stifle his discussions with me or to peg his talks to a fee schedule. I can,t see how any responsible physician is thinking of $15 and $20 payments.

    i am thinking of seeking out one of those concierge docs, where I pay $1000 or $1500 annually for unlimited access and no insurance gets between me and the dr. While that is silly for someone who doesn't go to the dr, it also makes sense as a plan for simplicity.

  10. #10
    Senior Member JaneV2.0's Avatar
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    Quote Originally Posted by iris lilies View Post
    ...

    i am thinking of seeking out one of those concierge docs, where I pay $1000 or $1500 annually for unlimited access and no insurance gets between me and the dr. While that is silly for someone who doesn't go to the dr, it also makes sense as a plan for simplicity.
    I'm probably going to have to see a doctor eventually--if only to have my knees fixed--so I have considered this. Or fee-for-service. I HATE insurance companies, which never should have been involved in health care in the first place, so anything I can do to obviate dealing with them is what I want to do.

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