How to avoid surprise charges from a wellness visit

Posted at 10:03 AM, Feb 19, 2020
and last updated 2020-02-19 11:03:52-05

If you are planning to see your doctor for a wellness visit, there are a few things that you may want to be aware of to avoid surprise charges later.

Many health insurers and Medicare will pay for an annual wellness visit which is mainly for discussing preventative care. Annual physicals also cover preventative care.

But, an annual physical may not be coded the same by your clinic because it may include more extensive exams and testing that is not typically covered under a wellness code. This could result in the patient being on the hook for some unexpected charges.

Some patients have also been surprised by hefty charges for concerns that were addressed during a wellness exam for things like a specific pain, skin condition, or health issue that was not considered to be preventative.

Patients have also been shocked to learn that a simple in office procedure like removal of a skin tag or mole could be considered as surgery and billed as such. This could result in a patient being responsible for paying hundreds or thousands of dollars for services that are subject to co-payments, deductibles, or not covered at all.

Here is what you can do to avoid getting hit with surprise charges:

  • When making the appointment, specify that the appointment is for a wellness exam. When checking in, specify again that this is for a wellness exam. When meeting with the doctor or staff, again specify wellness exam. If you have other health concerns that you wish to discuss, contact your insurer or the clinic to get an estimate of what you can expect to pay for addressing these concerns during a wellness visit.
  • There can be a lot of confusion and gray areas about what can be addressed in a wellness visit, and how things get coded for billing purposes. If you feel that something was unfairly coded or you were overcharged, discuss this with your doctor or billing staff, and ask for a correction to be made. If you cannot resolve the issue with staff or a supervisor, contact our Call 4 Action office for assistance.

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