Author Topic: billing for a well exam or yearly physical  (Read 2632 times)

xraygooch

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billing for a well exam or yearly physical
« on: June 19, 2009, 11:06:04 PM »
I had my children scheduled for a well exam.  After seeing the Dr. we got a bill for an office visit with multiple cpt codes instead of being billed as a well check.  When I called the office they said because when the Dr. asked me if I had any concerns I said yes and asked about a lump on my childs neck, it was no longer a well exam and could be billed differently.  Is this right?  This definitely made the office more money and resulted in a $200 bill instead of a $20 copay for a yearly well check.

Pay_My_Claims

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Re: billing for a well exam or yearly physical
« Reply #1 on: June 20, 2009, 05:59:06 AM »
Yes, it happens often. With a WCC they can't do a problem focused exam so it has to be one or the other. My physician would always ask which would you like to be seen for today.

PMRNC

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Re: billing for a well exam or yearly physical
« Reply #2 on: June 20, 2009, 07:13:43 AM »
Quote
My physician would always ask which would you like to be seen for today.
If they find a problem that's different but they should never ask the patient how they would like it billed.

 
Linda Walker
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Pay_My_Claims

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Re: billing for a well exam or yearly physical
« Reply #3 on: June 20, 2009, 10:48:14 AM »
Quote
My physician would always ask which would you like to be seen for today.
If they find a problem that's different but they should never ask the patient how they would like it billed.

 

No, she wouldn't ask how they want to be billed, but if you had (ear ache, foot pain, head ache, lump in breast) they wouldn't see you for multiple issues, you would have to determine what you want to be seen for that day, and thats how its scheduled. Because of the copay issues, many would schedule a physical, then pop an issue on the MD. Ok, do you want to be seen for your well womans exam or the bunion on your foot. Now when she is doing a physical, doing the breast exam, if she feels a lump, ask you about how long its been there, sends you to radiology, they find this or that, the physical has now turned into another exam.  I have seen plenty clients come in for a physical, but have flu-like symptoms. You can code a well visit with a dx of pneumonia!!

Michele

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Re: billing for a well exam or yearly physical
« Reply #4 on: June 20, 2009, 07:42:06 PM »
I'm confused how the bill went from $20 to $200.  If your policy requires a $20 copay for a visit you shouldn't have owed more just because they billed for both services.  I would make sure the claim was processed correctly, and verify with your insurance carrier if the provider could bill you for that amount.

Michele
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Pay_My_Claims

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Re: billing for a well exam or yearly physical
« Reply #5 on: June 20, 2009, 08:16:01 PM »
Some plans only have a copay for a well child check or a physical. If it was a problem focused exam it probably applied to the deductible. Thats what I was thinking.

PMRNC

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Re: billing for a well exam or yearly physical
« Reply #6 on: June 21, 2009, 09:42:08 AM »
For me here in NY it's the opposite, I don't pay a copay for well visits or immunizations.
Linda Walker
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Pay_My_Claims

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Re: billing for a well exam or yearly physical
« Reply #7 on: June 21, 2009, 01:51:01 PM »
I have had some with no copay, but the majority will have 1 physical cvg 100% ucr, ded doesn't apply. (that I have seen)