Sunday, January 24, 2016

How That "Free" Wellness Visit Can Cost You Twice

My client HR departments regularly receive employee inquiries based on this flaw in PPACA. I always explain during open enrollment meetings that your "free preventive" visit to the doctor is never free.  Instead, it is prepaid in your premium.  Once the government mandated a "free" preventive visit, carriers responded by increasing premium by about half a percent to account for the added cost.  And once again, in the never ending game of Whack-A-Mole, employers and employees take the blow.

Beyond that, your visit is rarely sans copay.  Yes, if you are in excellent health and have a purely preventive checkup in which your physician does not  follow up on any ongoing care issues (such as cholesterol, diabetes, blood pressure, weight management, etc.) you might get out of the doctor's office without a copay.  But for the other 80 percent of us, our premiums went up half a percent and we're paying the copay or the added cost of care under a fee for service plan.

Thank you sir, may I have another?

From Devon Herrick at NCPA:
Preventive care is supposedly free under Obamacare. However, a recent article in U.S. News & World Report discussed the confusion that often occurs when people see their doctor for their annual “free” wellness visit. The problem: it is easy to inadvertently cross the line into non-free medical services that cause the wellness visit to be coded as something rather costly. 
Patricia Jones thought she was getting the much-talked-about free physical under Obamacare when she went to see a doctor in May. But, she says, a few small things that happened during her checkup ended up making the visit cost more than $450. 
Indeed, asking the wrong question during a wellness visit can sometimes result in the physician using a different billing code other than the “free” codes for preventive medical services. 
In the process of answering questions from her doctor, Ms. Jones and her doctor turned a wellness visit into a diagnostic visit. Diagnostic visits are not covered under preventive care. Moreover, many people have high-deductible plans. A question or two, or agreeing to tests that are not medically necessary, can easily make that free wellness visit into a diagnostic visit that must be entirely paid for out of pocket. 
Stop for a minute and think about the implications. A wellness visit that does little more than take your blood pressure and ask how you’re feeling is essentially worthless if your doctor is not allowed to act on anything he or she finds.