When you go to the doctor for your annual check-up, if you have insurance, you may expect that visit to be fully covered. The I-Team learned that's not always the case.
Patients say they have been billed for asking or answering typical health questions at their wellness visit. Elaine Gearheart is one of them. She told the I-Team during a wellness visit with a pediatrician at her medical provider, she brought up how her child was getting headaches and then was charged.
"It really surprised me," said Gearheart.
"My daughter had been complaining about some headaches at school and the advice was to keep doing the log and maybe try a sugary drink," she explained.
"There was a $114 charge on there for an office visit."
Gearheart showed us the bill. Her insurance covered most of the charge. So, she only had to pay about $40. But when she called to dispute the bill, that didn't work.
"They were like well, they gave you a treatment, and therefore it's non-negotiable," Gearheart said.
Another mom, who wanted to remain anonymous, told the I-Team over the phone, she was charged an extra $70 at her toddler's yearly check-up visit for discussing a few typical health care topics like bed-wetting.
The woman learned the "medical visits" charge on her explanation of benefits included a "urinary incontinence" diagnosis.
Those medical billing cases involved kids, but we've also heard from adult patients who had similar experiences but with different medical providers like Kris Ender.
"It was a normal check-up physical which is supposed to be fully covered," said Ender, who said she was charged $78.65 for talking with her doctor about a minor eczema rash she had during her annual preventative exam.
It was billed to Ender's insurance as an additional office visit.
"Unfortunately that's the nature of our health care system's billing right now is a fee-for-service model," said independent patient advocate Chris Van Haren with A Better Way Professional Health Advocacy LLC.
Van Haren says what you talk about during your yearly check-up can cost you extra. It all depends on your medical provider's policy.
"If you have new symptoms that you want addressed, that goes above that preventative care, it's no longer preventative, it's now a diagnostic visit," she explained.
The Wisconsin Hospital Association echoed that explanation and provided the below response to the I-Team:
Patients who have questions about what health care services are covered by their insurance policies should seek this information from their health insurance companies. Typically, preventive wellness visits are fully covered by health insurance. These visits are focused on identifying potential health issues before they arise.
Problem-focused office visits, on the other hand, are treated differently by insurance companies, and such services must be coded accordingly by health care providers. These services related to a current medical issue may result in out-of-pocket costs for the patient.
This distinction in the types of care patients receive can be confusing to patients, and Wisconsin hospitals strive to educate those they serve about the costs associated with their services.
"It's really difficult. It's difficult to understand our system. It's just as difficult for the doctors, and all of the providers, to understand the system as well," Van Haren said.
As a patient, however, you aren't powerless. Van Haren suggests before bringing up a health concern, ask your doctor if you will see an extra charge. Before your wellness visit, you can also call the billing office and ask them the same question. Finally, you can always fight the charge, by filing an appeal.
"It's an uphill battle right now because everybody is short on time," she said.
She stresses you need to realize what you're up against. A lot of patients are rescheduling neglected doctors visits and COVID overall is still taxing our healthcare system.
For Elaine Gearheart, it's not about the money, it's the principle. The nearly $40 charge upset her so much, she switched providers.
"I'm one that likes to pay my bills on time, so I just ate the $40 and decided that was the last $40 they were going to get from us."