PORT WASHINGTON, Wis. — Mary Caravella says on her March 4 Medicare wellness exam, she had fifteen minutes of face time with her physician.
"When we got the bill I was just astounded," said Caravella.
"I did not have a physical exam or anything," she added.
The bill totaled $900. After insurance was applied, she was responsible for $129.41, which would be fine under different circumstances, but this appointment was supposed to be fully covered.
According to a spokesperson for the Centers for Medicare and Medicaid, "If a person with Medicare has had Medicare Part B for longer than 12 months, they can get a yearly 'Wellness' visit to develop or update their personalized plan to prevent disease or disability based on their current health and risk factors. The yearly 'Wellness' visit isn't a physical exam. Medicare covers this visit once every 12 months."
Caravella's original bill showed $355 was for the annual wellness visit, which Medicare fully paid for. But, the second charge for $545 was labeled "preventative," which wasn't fully covered.
"We've been fortunate that maybe we can afford it. So, it's not a matter of money. It's a matter of principle and how many people are getting hurt by this," said Mary's husband, Tom.
The couple's medical provider is Aurora Health Care. We contacted Aurora and a spokesperson provided the below statement:
"While we cannot comment on the specifics of any patient's care or billing, it is our practice to investigate patient complaints and make necessary efforts to resolve their concerns. Patients unsure how their insurance handles claims for office visits should contact their insurance provider. Our commitment to helping people live well includes providing our patients assistance in navigating the financial costs of their health care. Patients can access this helpful information on our website and by contacting our Patient Contact Center at 800-326-2250."
Days later, we learned Aurora removed Mary Caravella's charge. Since Caravella already paid it, she'll be reimbursed.
Caravella told us when Aurora called her, a representative also let her know they would be training staff on how to properly handle Medicare wellness exams so that if a patient comes in and the services extend beyond what is covered, they will let the patient know they could be charged.
Vicki Buchholz is with Wisconsin's Board on Aging and Long Term Care.
"There needs to be that communication to understand when did that visit change," Buchholz said.
"If the provider performs additional tests or services during the same office visit, then that portion of the office visit becomes a chargeable service which may cause the beneficiary to have to cover the deductible or the 20%. Another reason why a person may find themselves with a charge for these visits is if their physician does not accept Medicare 'assignment' for their services, which means the provider is allowed to charge up to 15% over Medicare's approved amounts," she explained.
Caravella says she didn't discuss any health concerns during her visit. She says she only agreed to get her prescription refilled.
Buchholz says despite what may be considered a surprise bill, that shouldn't deter seniors from speaking up.
"If they walk in for a wellness visit but they've really got a pain, they need to talk about that," she said.
"Beneficiaries are encouraged to ask their doctor at the start of the appointment what is included in their visit, so they can then decide if they want to make another appointment for other services or if they want to save the trip in for that other visit and combine the two, which means they will be charged the out of pocket after Medicare," she said.
If you have questions about your Medicare coverage, you can call the Medigap Helpline Services. The toll-free number is 1-800-242-1060.