When Beverly Dunn called her new primary care doctor's office last November to schedule an annual schedule, she accepted that her Medicare coverage would take most of the tab. The doctor spent a lot of time with her.
Until she got the bill: $ 400.
Dunn, 69, gave the doctor's office assuming there was a billing error there. But it was not mistaken, she was told. Medicare does not cover an annual physical examination.
Medicare rules confused Austin's people. Federal law prevents the healthcare program from paying for annual physics, and patients who receive them may be on the hook for the full amount. However, beneficiaries do not pay anything for an “annual fitness visit,” which covers the program as a whole as a preventive service.
“It's very important that a person uses, when they call to make an appointment, the magic words that, 'annual fitness visit,” said Leslie Fried, senior director of the Benefit Access Center at National Council on Aging. Otherwise, “people believe that they are making an appointment for an annual fitness visit and that they are physically complete.”
Annual physical as well as blood work or other tests usually involve a medical examination. Normally, the annual fitness visit does not include a physical examination, except to check normal measurements such as height, weight and blood pressure.
The focus of the Medicare health visit is to prevent disease and disability through “personal prevention plan” for future medical issues based on the health and risk factors of the beneficiary
At their first fitness visit, patients will often complete an assessment questionnaire. risk and review their medical and personal history with their doctor, nurse practitioner or doctor's assistant. The clinician will usually produce a schedule for the next decade of mammals, endoscopes and other screening and will evaluate people for cognitive and depression problems, as well as their risk of drops and other safety issues.
They can talk about pre-planning with beneficiaries to make decisions about the type of medical treatment they need in the future if they cannot make decisions for themselves. Beneficiaries may also receive other preventive services, such as flue shots, at these visits without charge.
When a Medicare program was established more than 50 years ago, its purpose was to diagnose and treat older illness and injury people. Preventive services were not normally covered, and routine physical checks are explicitly excluded, as are routine cosmetic and dental care, eyeglasses and hearing aids. coverage based on the annual fitness visit. Medicare beneficiaries pay nothing as long as their doctor accepts Medicare.
But if a fitness visit visits the preventive services under separate cover in diagnosis or treatment – whether the doctor or the patient – Medicare beneficiaries can usually
(this can be a problem when people in private plans also receive preventative care and can influence patients of all ages, the ACA requires insurers to provide cover, without equal pay, in the case of preventive services in the field, including immunizations. visit to prevent, the patient may receive charges.)
And to provide more confusion, Medicare beneficiaries can choose a “Prevention to Medicare” within the first year of entering Medicare. Part B, which covers doctor services
Meanwhile, some Medicare Advantage plans cover annual members' free physics. r to assess or treat chronic conditions such as diabetes or arthritis at the fitness visit, said Michael Munger, who chairs the board of the American Family Physicians Academy. But Medicare usually does not cover laboratory work, such as cholesterol screening, unless it is connected to a specific medical condition.
Practicing Munger in Overland Park, Kan, staff usually ask patients who come in for a healthy visit to sign the “advance notice of non-prosecution beneficiaries” acknowledging that Medicare cannot pay for some of the t services they receive.
As long as the beneficiaries understand the rules of envelopes, it is not a problem in general, Munger said.
“They don't want to come back for a special visit, so they realize that there may be extra charges,” he said.
B&M may not be the only person who is not clear about what is meant by an annual fitness visit, Munger said. Suppliers may be eliminated if they think that it is just another task that adds to their paperwork.
A recent study published in Health Affairs magazine found that just over half of Medicare's eligible patients in 2015 offered a healthy visit. That year, 18.8 per cent of eligible beneficiaries received an annual visit to wellbeing, the analysis was obtained.
Primary care physicians generally want to see their patients at least once a year, said Munger, but it does not necessarily have a full physical examination.
A healthy visit or even a visit to an ankle that had a branch on her, could allow doctors to get in touch with patients and make sure they are in line with preventive care and other care, said Munger
Dunn said when she called the doctor's office under the $ 400 bill, the staff told her she had signed papers that had not paid any Medicare.
Dunn does not dispute that.
“There were many papers I signed,” she said. “But no one told me that I get a bill for $ 400. I want to remember that. "If she comes straight in for an annual well-being visit, she will see a doctor's assistant.
Dunn is thinking about her choices. She wants to stay with her new doctor, who was highly praised, and she is worried that he might She struggles to find another one who accepts Medicare. But it seems that $ 300 is too long for her to check.
“The whole thing was so stressful to me,” she said. “I lost sleep for a night. It's not that I couldn't pay it, but it wasn't right. ”
Kaiser Health News is a non-profit news service covering health issues and is an independent editorial program of Kaiser Family Foundation is not affiliated with Kaiser Permanente.