r/mildlyinfuriating • u/MassiveCup5591 • 24d ago
I'm slightly vexed Healthcare in the US
Waiting for the doctor for a simple physical. I get handed this.
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u/Accomplished_Cod7334 24d ago
You'd think a yearly wellness exam would cover any concerns the patient had about their wellness
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u/Mateorabi 24d ago
“Should I be worried about this GOING FORWARD?” There. Now it’s “preventative” since it’s about future effects or the possibility of progression/escalation. Suck it insurance.
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u/Specialbonbon 24d ago
This is literally Cigna with any authorization for any reason that any doctor is requesting. Their favorite word is no
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u/HamSlammer87 24d ago
My Dr. set up a CT scan to check my kidneys. Recommend one with dye and one with out to check my arteries.
Insurance denied coverage because there wasnt enough info on what was wrong. BRUH, thats why she wanted to look! The fuck am I paying these people every week for?
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u/Specialbonbon 24d ago
my favorite is when specilaity doctors have to justify to other doctors (not relating to the main dr's specialist AT ALL) why they want to perform a procedure on someone just to convince the insurance to cover it.
In no world should a cardiologist have to do a peer-to-peer with a neurologist as to why a heart procedure needs to be performed on someone so insurance pays for it??? Truly insane when you think about it
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u/Ambitious_Jelly8783 24d ago edited 24d ago
Weird discoloration on sole on feet. Got biopsied.
Insurance: No, that shit is cosmetic.
All was good, biopsy was negative, I promptly changed insurance, fuck that shit.
Edit. Not provider, insurance Co.
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u/PM_Skunk 24d ago edited 24d ago
I had this happen when they removed and biopsied a roughly 2" x 3" LUMP from under my skin, over my collarbone. Thankfully, I had a good rapport with the surgeon and he actualy fought the insurance company FOR me, but still. (edit: single word typo)
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u/Acceptable-Post733 24d ago
Had a dermatologist ask me like five times if a bump under my skin hurt and or irritated me. I kept saying not really. He asked again and a nurse in the back was nodding yes while staring at me. I said yes and he was like, great! If it’s health related they could bill the insurance. But if it was cosmetic, I would have had to pay.
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u/PM_Skunk 24d ago
Yeah, that was basically how it went. "Wow, it must be REALLY PAINFUL wearing a backpack, huh? A backpack that you absolutely HAVE to wear to work, right? Yeah, that's what I thought."
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u/Condition_Dense 24d ago
I had a lipoma I can’t spell that but basically a fatty tumor usually benign on my neck. They didn’t cover the biopsy of it but they covered the removal WTH? It was painful hence why I had it removed and it kept spraying stuff out when I squeezed it and I was worried about infection.
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u/PM_Skunk 24d ago
You spelled it right. And I think that's what mine ultimately was too, just collarbone. Since it first developed after a collarbone fracture, I just wrote it off, until I didn't want to any more. I went in PLANNING to pay out of pocket until the surgeon stepped up and said "nah, we'll make this work."
Yours covering the removal but not the biopsy is WEIRD for sure.
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u/renwill 24d ago
good on you for getting it checked out. My father died from melanoma that started on the bottom of his foot, which neither he nor his dermatologist had noticed
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u/ShataraBankhead 24d ago
My dermatologist did a biopsy of a spot on the arch of my foot. It had grown larger over several years. It really looked like melanoma. Thankfully, it was benign.
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u/inplayruin 24d ago
Cosmetic? The fuck do they think you are doing with your feet?
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u/Syphist 24d ago
Insurance shouldn't be allowed to deny coverage for things your in network provider says you need. They trust the provider to be in your network, they should trust every decision they make.
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u/BellaMentalNecrotica 24d ago
I used to have Tricare when I was on my dad's insurance. I put a sewing machine needle through my finger on a Saturday evening. Urgent care was open so I called and explained what was going on as I wanted to avoid the ER for something that was non-emergent/non-life threatening. But I still felt this was urgent enough not to wait until Monday as the needle had broken off in my finger and I didn't want it to get infected. So, urgent care makes the most sense, right?
They said tricare requires a referal for urgent care. WTF. Its called URGENT care for a reason. So I had to go to the ER despite being something that urgent care could have managed.
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u/Specialbonbon 24d ago
For urgent care is WILD
And this doesn;t even include the VA... forget about it rip
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u/Condition_Dense 24d ago
My old plan didn’t have an urgent care in network near me, unfortunately I went to the ER for stuff and sometimes it was billed as urgent care because the ER I went to was also an urgent care.
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u/TheDayUnderway 24d ago
For anyone reading, sounds like this was Tricare Prime. Tricare Select lets you go wherever you choose without a referral besides a few specific instances like therapy or any high-cost procedures. My doctor still tries to give a referral for everything because she’s so used to it from other insurances, but I rarely need one to go see a specialist. All this aside, I hate the American medical industry as a whole.
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u/Odd-Character2025 24d ago
I’ve never had a referral for urgent care and I go at least 4 times a year with Tricare. They always cover it 100%.
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u/ExtraordinaryDemiDad 24d ago
Literally. I ordered imaging for suspected infection of the heart. It took days of fighting with them. They denied for the same as what you described. The imaging was positive...it's like I needed it to make the diagnosis they needed to approve the image in the first place...
TLDR we are cooked
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u/Pristine_Ninja1810 24d ago
My doctor ordered Vitamin D testing and insurance refused to pay unless I had a diagnosis of Vitamin D deficiency, which of course you can’t get diagnosed without a test. So I had to pay out of pocket and when it came back confirming a deficiency insurance refused to reimburse because the test was “pre-diagnosis”.
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u/Fearless-Cattle-9698 24d ago
Don’t kid yourself. Who else is gonna pay for their CEO’s bonus this year?
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u/InspectionTall2886 24d ago
My insurance denied my surgery because they wanted to know if I had secondary insurance 💀😬
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u/Roamingrevered 24d ago
I’ll raise you one. Five years ago Capital Blue denied surgery on my ankle. It had been shattered in a car collision and I needed several metal plates and screws to keep it together.
their reason for denial was that I have two feet and did I really need both.
The judge really loved hearing that when I sued them.
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u/Little-Ad1235 24d ago
Look, I'm not saying whether it was right or wrong. I'm just saying there's a reason most people sympathized with Luigi.
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u/FutureFreaksMeowt Aqua Tofana save us from these fuckass men 24d ago
"Eh, cats get around with three legs, I'm sure you'll be fine" is WILD work what the fuck.
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u/Successful_Guess_762 24d ago
And I raise you one, daughter was bitten by a spider at 6 years old, hand swelled up, couldn’t move it, turned dark red, went to ER, lost of sight, limb, life, criteria, insurance didn’t want to pay, because I hadn’t caught the spider to prove if it was poisonous.
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u/mozillazing 24d ago
the first 700/month premium is just a tribute
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u/InspectionTall2886 24d ago
I had already hit my out of pocket. Once I told them I have no other insurance they said it’ll be adjusted. Hopefully I’m not paying 58k for my 1hour surgery and 1 hour recovery room. They are charging me $3k for a CBC 😂
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u/The_Cait_Sidhe 24d ago
My insurance referred me to their fraud department. Meaning they had their fraud department investigate me for insurance fraud because they said I had secondary insurance I hadn't reported.
What actually happened was a family member bought separate DENTAL insurance for me to help with some work I needed done. I checked with my HEALTH insurance company before they did that to make sure it was allowed, and wouldn't interfere with anything, and they said it was fine.
It was indeed fine, per their rules. But, every single time I tried to fill a prescription, they'd bill it, and apparently something would pop up saying there was a second insurance plan detected, and to the fraud department I'd go. Where they'd find nothing wrong again.
The representatives I spoke with either couldn't or wouldn't put any notes in, or stop it from happening. So a couple times a month I'd be alerted that I was under investigation, and be unable to have appointments or refills covered while I was being investigated. I'd have to call, be on hold for hours, send in documentation that it was dental and not health insurance, wait til they processed everything and reactivated my health insurance. The process was usually a few days of fighting, assuming I got someone who knew how to help.
After months of this, I couldn't take the stress any more and asked my family member to cancel the plan they bought for me. I appreciate their effort and generosity, but repeatedly getting messages that I was being investigated for insurance fraud was getting to the point of making me physically ill. I finally broke when I had a follow up to discuss biopsy results, and got a call the day before that I was being investigated again, and had to cancel my appointment. That was only a few days after I had corrected the issue following a medication refill.
So anything dental is out of pocket now. As intended, I assume. Anything to encourage customers to politely die and spare the company having to pay.
Same insurance also went back and forth approving a surgery. Got it all fixed. Show up to surgery. AS THEY'RE PREPPING ME they come tell me billing isn't going through. Fortunately someone in billing called and got it handled, but jfc.
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u/Few-Grass2724 GREEN 24d ago
I was bitten by a raccoon when I was taking trash outside in Florida. My insurance wanted to deny my rabies shots coverage unless I proved I wasn’t doing anything dangerous (like bungee jumping with raccoons or something?) so I sent them my Ring video. $37,000 🙄🙄🙄 imagine if I didn’t have evidence? Insane behavior for something I pay for.
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u/Unlucky_Twist_6595 24d ago
And inevitably this path leads to more tests, more visits, and ultimately the CT scans she was requesting in the first place. Insurance is a sick joke.
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u/T3hSpoon 24d ago
I wonder if you break the doctor's fingers, do they get their CT covered by their insurance, or does the insurance company needs to send an auditor over to see if the doctor can still hold a pen to continue signing off overpriced meds and inflate bills? /s
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u/LurkmasterP 24d ago
Insurance companies are businesses before anything else. The first priority of a business is to bring in money, and the last priority is to spend money. Providing service to customers is literally the last thing they want to do, because that costs money. I guess if we don't like it, we could buy enough stock to become major shareholders so we can change it. Oh wait, that's right, insurance companies don't let you do that. They're a special protected class of corporation.
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u/BluesRuseCruise 24d ago
I wish it worked like that. Anything past saying “hi” and getting my weight taken and lungs listened to is a separate office visit.
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u/AnimalFarm20 24d ago
Nope, got the same notice. If you bring concerns about anything - it is no longer a preventative visit. Crazy.
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u/DulceEtDecorumEst 24d ago
I do procedures, and if my patients bring in any concern that requires a med change or anything other than a refill I need to warn them that it becomes a visit on top Of a procedure with another co-pay.
Reason being is I have auditors breathing g down my neck looking at what I do and if they notice I did a visit on top of a procedure and didn’t bill it they label me non compliant with billing standards and can get fired for handing out free care.
I often tell them “ look I can do this today right now for a copay, or you can message me tomorrow about it and get it for free 👀 “
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u/tealestblue 24d ago
It does. I’m a medical coder. If you discuss chronic conditions that are stable and preventative things it’s covered under the annual. If you bring up a new problem or have a chronic condition that is worsening and needs new meds or something, then it’s outside of the preventative. Clinics don’t make these rules - the AMA does.
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u/Henry5321 24d ago
My doctor will triage any new concerns but anything worth pursuing they’ll refer me or have me schedule a focused office visit.
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u/tealestblue 24d ago
I wish more did that! Helps them keep on schedule.
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u/JHoney1 24d ago
I would love to. Unfortunately admin forces us to have enormous panels and my next available is over a month out.
It sucks to say, yeah I understand your knee is really hurting. Come back in a month and we can talk about it. 😭
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u/Pure_Temporary_6349 24d ago
As a physician I think it's bizarre that the AMA, a private professional org most of us don't even belong to, sets the CPT guidelines-- but the other part is that CMS and insurers choose to use the CPT as their standard. Otherwise we could just tell the AMA "cool story, bro" because they don't have any political authority.
Most people don't know docs can get penalized for under coding as fraud, if they get audited, but coders know!
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u/Fine-Celebration1223 24d ago
Interesting. I thought up-coding got more attention by the fraud investigators.
I do find the co-pay penalty to be a huge concern. When patients are afraid to mention other conditions, delays in diagnosis and care can occur, potentially costing the insurance companies more money than if the problem was addressed earlier, especially while many are struggling in this economy.
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u/Pure_Temporary_6349 24d ago
Undercoding is seen as a bribery scheme to get patients to see you instead of a competitor. But you are right about copays. We should have zero co pays or deductibles for anything. Publicly funded single payer with no point of service cost sharing is the best solution, along with mandated paid pto so ppl can get time off work.
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u/emma279 24d ago
Codes are utter BS. Thanks to Dr Elizabeth Potter who is fighting them.
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u/Sherifftruman 24d ago
So did something change in the last couple of years regarding this? My doctor never used to do this, and then all of a sudden they started doing it.
And does the ruling about this say that it’s required? Because I think it’s really more like doctors offices realized that they were missing out on a revenue stream and decided to start doing this to make more money→ More replies (8)20
u/meagercoyote 24d ago
The big thing that's changed is private equity buying up doctor owned practices. For many years, medicare and other insurance companies have been decreasing the amount they pay doctors. They also pay extra for the same work when it's done at a hospital. So most graduating doctors go work for a hospital now instead of opening their own practice, because the hospital pays better, and lots of physician owned practices have shut down because of financial issues.
In the last few years, private equity has gotten in on this, buying up tons of struggling practices and turning them from small businesses that cared about their communities into profit churning machines.
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u/Significant-Ad-341 24d ago
For real. I had this conversation with the front desk team and I'm like "well bill it however you want but I'm asking everything that comes to mind
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u/Brock_Lobstweiler 24d ago
Part of it is because no one an afford a ton of different appointments throughout the year, so we hold things til the standard appointment.
Because we have to pay cash money AND have to take time off work AND appointments are too far apart AND too short.
It's all designed in such a way to make this kind of conversation the only realistic outcome.
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u/Competitive-Elk-5077 24d ago
Mine didn't charge me, but got upset when I mentioned medical concerns I had during my physical. Great Healthcare in this country
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u/buzzybody21 24d ago
At least the doctor warns you…that’s saying more than most providers.
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u/Rdbjiy53wsvjo7 24d ago
My kids doctor office kept calling and telling us we needed to assign them as their primary in our insurance portal, and they called like 3 times within 2 weeks, finally on the 3rd call they said that some insurance plans if you don't assign the PC on your insurance portal that the bill will be higher.
They could've just let it go, but was really appreciative of them trying to save us money when they didn't have to.
(FYI, it can take weeks in the insurance portal to update, so that's why even after we had it assigned, it kept showing up as not so we had to get a confirmation code saying we had already assigned our PC)
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u/notgonnabemydad 24d ago
My PCP's office did that too. I was appreciative of their efforts to protect me.
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u/totally_not_a_dog113 24d ago
That explains a lot. I was assuming my PCP was complete garbage because she only asked about my exercise habits and not my PCPs (diagnosed cardiac arrythmias that are causing long term damage to my heart) or when the last time I had a pap smear was.
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u/Sparkysparky-boom 24d ago
The pap smear is her not being thorough- I believe that’s part of preventative visits.
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u/Electronic_Sky_207 24d ago
Yup. If you check your insurance plan they’ll have an itemized list of which things are covered at a wellness visit based on sex and age.
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u/girlikecupcake MILDLY? 24d ago
Depending on where you're at, pap smears are solely handled by a gynecologist. My primary care never asks or mentions about pap status and while this office used to be able to do a basic pap, they stopped doing that years ago so now you have to basically have two physicals at two different locations when you're due for one. God forbid you actually have any kind of issue going on when you get your routine pap and exam because then you're billed for a specialist visit.
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u/Secret_Cod_749 24d ago
Paps are generally part of a well woman visit that is separate from the annual preventive visit.
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u/joekandy 24d ago
Yeah I actually viewed this as OPs doctor’s office doing them a solid.
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u/Taste_the__Rainbow 24d ago edited 24d ago
This is because of the No Surprises Act, which Dems were able to pass during Biden’s presidency. They were very limited due to having a 1-vote margin and Manchin/Sinema.
Every company in America treats its employees and customers as bad as it legally can. So the only way to make them do better is to elect more democrats.
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u/No_Seesaw_3897 24d ago edited 24d ago
American healthcare at its finest.
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u/lenswipe GREEN 24d ago
weathcare*
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u/tonymyre311 24d ago
*wealthcare
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u/lenswipe GREEN 24d ago
my bad. I'm only on coffee #1
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u/soherewearent 24d ago
Your insurance may apply a copay for this statement because it's outside the discussion.
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u/Ok_Neighborhood_470 24d ago
If you read this warning twice (we're tracking your eyeballs), you may be charged.
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u/LetshearitforNY 24d ago
Yupp this happened to my husband. He had his physical and brought up back pain. The doctor didn’t treat the back pain, but it was still $400.
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u/DamUEmageht 24d ago
I’d toss that shit out and say, “prove it”
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u/dalton-watch 24d ago
“The doctor misunderstood, I did not mention back pain I said it looks lack rain.”
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u/LetshearitforNY 24d ago
We even tried to fight it but nothing we could do. They were gonna send it to collections and it’s not worth ruining his credit score over.
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u/starrymahogany 24d ago
And here I thought they only charged extra for what the doctor said, but now patients have to watch what they say now
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u/NotSoLittleTeapot 24d ago
They're actively trying to keep us from getting care.
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u/satbaja 24d ago
I took my five children to the clinic for wellness exams every year. Preventative care is 100% covered. They would always send me a bill for a copay. I would dispute it and get it removed. The next time I brought them in, they asked for the copay up front. I called the insurance on the spot to clear this up. My card says no copay for preventative care. The insurance company said they are allowed to charge a copay for the "nurse visit" if the nurse takes their vitals instead of the doctor doing the wellness exam.
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u/TheBeanConsortium 24d ago
What a farce. I've NEVER had a doctor check my vitals. It's always been a medical assistant or a nurse.
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u/LolaBabyLove 24d ago
The best part is you no longer have a doctor as your primary care. It’s a PA or a nurse who can write prescriptions - like an APRN. But the copay doesn’t change for the service despite the provider having had less schooling. AND my last PA left the practice so I had to PAY to establish myself as a new patient with the APRN who replaced her or they wouldn’t allow me to refill any of the prescriptions I’ve been on for YEARS through the same practice. I asked - aren’t they both overseen by the same doctor? Yep! Doesn’t make a lick of difference because the doctor hasn’t personally seen me. It’s all a money grab at this point.
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u/poqwrslr 24d ago
That actually is illegal. That is double billing and to charge for a new patient when you are not is insurance fraud. Just because it’s a new provider does not make you a new patient. If it’s the same practice then you are established patient.
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u/TheBeanConsortium 24d ago
Agree with the other person. I don't think they can justify that unless you haven't been to that provider for a certain amount of time. Not sure what the legal minimum is but assuming at least a year.
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u/Omnom_Omnath 24d ago
so did you still refuse to pay? thats fucking insane, and has got to be illegal.
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u/BarbequedYeti 24d ago
Nothing in healthcare billing is 'illegal'. If so, the whole damn system would be serving life without parole. It is by far one of if not the worst system we have ever developed and we are the only ones who use such a system for healthcare.
The US doesnt care about itself. It cares about money. Nothing else.
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u/ajobforeveryhour 24d ago
There are a lot of things in billing that are illegal, caught and prosecuted.
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u/elijw514 24d ago
The foundational incentives of the healthcare system are completely broken. People getting charged when they shouldn’t, insurance choosing profit over helping their patients, LOBBYING….. Yeah there are lots of things in billing that are illegal and can be prosecuted. But you’re missing the point here. Our healthcare system is broken and we need to fix it. And the countless amount of rich CEOs and shareholders and corporations that made it this way need to be held accountable.
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u/Calm_Initial 24d ago
Similar. Preventative Pap smear appointment- supposed to be free. And yet there are loopholes because they charge you for the lab to read the Pap smear thus leaving a bill. And it is allowed because they send out the Pap smears to be read so that is not a part of your “free exam”
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u/Keldaria 24d ago
Honestly it gets worse. At least in this scenario you have “some” choice in that you can opt to not ask any questions or say anything that might turn a 100% covered visit into a paid visit.
For colonoscopy exams (the really in-depth ones) are also supposed to be 100% covered as preventative care. However if they find anything they want to take a closer look at, then it becomes changes to a diagnostic exam which magically turns into a $8,000 medical bill even though they don’t do much they weren’t already doing or prepped to do. Congrats we found something concerning, how about a massive unexpected bill on top of all that worry and concern
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u/Prestigious_Pay2759 24d ago
same with diagnostic mammograms
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u/SuperSailorSaturn 24d ago
Age limits shouldnt be a thing for mammograms and other kind of test for cancer.
I had to go to instacare to get an order for a diagnostic mammogram because I couldn't just get one scheduled because I wasn't 40 years old. Despite being "too young" and had "no immediate family members who had cancer so you shouldnt either," I had breast cancer.
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u/a_tattooed_artist 24d ago
I do have a family history of breast cancer and asked for a mammogram early (at 38) and was denied.
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u/raya_sun 24d ago
This happened to a friend of mine, who lost her mother to breast cancer. She's in the med industry so knew how to fight it.
She was diagnosed that same year, late 30's.
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u/meh_dontcare 24d ago
These are the things that make me hate it here some days. It's like letting us die is okay because "you're too young.". You're never to young for cancer.
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u/garitone 24d ago edited 21d ago
But it's damn near impossible to know what is and what isn't going to incur a charge. At my physical my doctor asked if I wanted him to refill a long-standing prescription and I said "sure." I was charged a $75 office visit fee for that since it was coded as diagnostic, not preventative.
Edit: That doctor retired, so I was going to see another doctor in the exact same hospital department (same freakin' hallway!) for my next physical. I found out there was going to be a 'new patient fee' (even though I had been going there for 15 years) and nobody could give me a straight answer how much it would be (ranges were $370-$1041). I was able to find another clinic in town with no similar fee.
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u/Electric-Sheepskin 24d ago
I was just commenting elsewhere that it's not even worth going to the wellness exams anymore unless it's the only time you ever see a doctor. Why? Because it's so difficult to get out of there without being billed for a full visit, and if you're going to be billed for a full visit, you might as well talk talk about all of the things that you need to talk about, or as many as they will allow.
The doctors around here charge $160 – $190 for an office visit, which is what I have been billed for my wellness exam exams because of some bullshit like a refill like you described. So I don't even go to wellness visits anymore because of that. I'll schedule a problem appointment and get everything done that I can because fuck trying to sit there not asking any questions, not answering certain questions, doing your best to not incur a full charge during your wellness visit, and then oops, there's that one question and now you get to pay for a full visit without the full visit service. It's infuriating.
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u/practical-animal667 24d ago
I had this sign at my checkup a few months back, but I had to sign it saying each concern I bring up extra would be something $50+ dollars or something. Doctor asked me in the room if I had any other concerns and I said "yes, but I can't tell you according to the paper I signed or I'll get charged extra". She looked very unhappy.
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u/Fried_puri Bazinga! 24d ago
My doctor asked me that and I told him something similiar. He said it’s ok, that I should tell him and it won’t be an issue with insurance. So I did.
It was an issue with the insurance.
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u/shaddowdemon 24d ago
Moreso an issue with him. Insurance isn't in the room. He chose to have it filed as a normal appointment.
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u/ExtraordinaryDemiDad 24d ago
No, they actually do read our notes. They will "randomly" request dozens of charts to audit every month. They even use AI to change our charge levels/codes after we and then our billing team review and do our own billing. They've been doing that before AI was cool, actually. This gets especially tough if someone is in pain after an MVC and doesn't file a claim through their auto insurance. They will catch that and then say "nope, that's auto's problem" in 0.2s, leading to the patient getting a bill and then having to retroactively pursue their auto insurance who is also going to look for a reason to deny payment.
Some days I'm like...if they're gonna do this...why am I bothering to pay a billing team? It's like how we have to guess our taxes by paying people to do them and then the government is like, "nah, actually..."
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u/robotscantrecaptcha 24d ago
But if the doctor needs to order tests, she will have to attach that order / referral to a specific diagnosis which will get the test covered by insurance. So the diagnosis or code will need to be added to the appointment.
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u/shaddowdemon 24d ago
I mean, yeah, but then he shouldn't have said it wouldn't be a problem. A doctor CAN just answer a question without vigorously documenting something if it's for the benefit of the patient. Especially if it's not a serious issue.
But if he wasn't going to do it without billing for it, he shouldn't have told them that.
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u/Pmod1980 24d ago
Agree. I do everything at a wellness visit including refilling meds and referrals for other things. I only bill for the well and don’t put another code to bill for a sick visit. The higher ups tell us to do it, but I refuse because it’s unethical.
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u/grape-fruit-witch 24d ago
Your patients are lucky to have you. Any chance you're in portland oregon? Lol
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u/Federal_Penalty3937 24d ago
Does anyone in the US know anyone else in the US who thinks health insurance is working great?
Do people working at BCBS, Cigna, United, etc even think they’re doing a service? Or do they also think they’re just leaches on society?
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u/whispernotaroar 24d ago
I worked for Aetna doing prior auths for a little while before I went back to school, and the only time I didn’t vaguely hate myself was right at the end when I didn’t care if I got fired and I started approving basically everything. It was a glorious little run.
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u/Proper-Gate8861 24d ago
My husband left a health insurance company because he couldn’t stomach working for one anymore.
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u/BaconBikes805 24d ago edited 24d ago
This just happened to me last week. First annual physical in a new health system using Blue Cross Blue Shield at UCLA Health. I pay $963/mo. insurance premium for the shittiest Bronze plan.
Waited months for an appt w GP who is not my first choice because mine was booked into next year. Had to sign a waiver along these lines but much longer than OP's and electronic. I had to ask, what is included in my annual physical? Basically lab work like iron and cholesterol, weight, blood pressure etc.. They ask you if you smoke or drink too much or are depressed. No discussion of womens health allowed, no discussion of ailments you might be experiencing permitted.
To explore adjusting a dose for a medication I've been taking for over 20 years, they referred me to an endocrinologist who is booked out until next March.
If I was in cardiac arrest, I'd have been lucky if they dialed 911 for me. Probably would have made me do it myself.
And the media struggles to understand why Luigi is a folk hero, smdh.
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u/ItsFreakinHarry2 24d ago
And people use the “you have to wait months for an appointment” to say why non-US healthcare sucks when literally the same thing happens here AND we get to go bankrupt when we our appendix ruptures!
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u/scoo89 24d ago
I'm in Ontario Canada and I needed a tetanus booster (I realized I hadn't had one in 14 years) so I called up my family doctor on Monday, had an appointment on Friday at 10:45. I was in and out before 11. The reason it took longer was because my doctor asked how my new cholesterol meds were working and if my boys were adjusting well to being back in school.
I paid $3 for a coffee to bring to my mother in law (who works as a receptionist in the same building for an eye doctor) and $4 for parking.
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u/SpecialistCut7101 24d ago
Look, a lot of rich people paid a lot of money to brainwash me to not believe you, so I’m gonna side with the billionaires on this one and die in a hole like they would prefer
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u/CharmingSyrup2685 24d ago
For a tetanus booster I will say in both the US and Canada you can get that at most pharmacies and can usually find one to get it same day. I’ve had it done in both countries. Now I do have insurance through work here that covered it, but for others they would have to pay I believe.
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u/scoo89 24d ago
Sorry if I wasn't super clear. My point was more guided towards the myth that Canadians wait forever versus saying anything about an American having to wait at all.
I do appreciate your unique insight.
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u/CharmingSyrup2685 24d ago
This exactly! I moved from Canada to the US due to work. Everyone tried to say how lucky I’d be without wait times…I had a major stomach issue this year and my GP said I needed to got to a GI doctor. My office is in a building with about 20 GI specialists, I go to make an appointment and they say I could see a NPH in September or a doctor in December. I hadn’t eaten real food in 3 weeks at this point and was in chronic pain. They said if I went to the ER (which of course that more money to pay) that could expedite me and get me in in 2 weeks. But that’s just me also wasting ER time to get an appointment. The grass is not greener at all here.
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u/SigismundsChair 24d ago
Remember when they told us gov healthcare would lead to “death panels” rationing care
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u/turtletechy 24d ago
That's wild to me because for me, that visit under a UHG plan didn't cause any issues with mentions of things going on. I had one where I brought up developing issues with hand pain and stiffness. Labwork was even no copay for much of it.
Like, the whole point of these is supposed to be to get a good chance to bring up minor things before they become major things.
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u/TeetheCat 24d ago
Ive been seeing this crazy thing online this year. Isn't anything you talk about preventative care? I mean unless you are there with a bleeding extremity? I really hate insurance companies of all kinds.
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u/Immature_adult_guy 24d ago
Unfortunately no. If you say something hurts or is infected then it’s already a problem.
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u/PapayaNurse 24d ago
Perimenopause symptoms being addressed are apparently not preventive care. I’ve been waking up so sweaty that the sheets are damp, window unit AC on full blast I stand in front of 2 times minimum each night to try to cool down, central AC running so room is a comfortable 70-72F. I wake up about every 2 hours because I’m so hot or thirsty, I drink about 2 liters overnight. I’m exhausted, it’s affecting my ability to work as a nurse, I’m irritable, etc. from really poor sleep. Too bad, it’s not preventative care.
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u/Working_Rise8592 24d ago
Isn’t the point of a wellness exam to…make sure I’m well? If I have concerns about something I might not be well…hence why I’m getting a wellness exam…
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u/lenswipe GREEN 24d ago
no, it's a box checking exercise so insurance companies can pretend to give a fuck
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u/IlliniDawg01 24d ago
And they only include those items because legislation literally forced them to.
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u/SirHippocrates 24d ago
Unfortunately this is why it's so minimalistic; the insurance companies do not see it as valuable so they will only pay for exactly what they were mandated to pay for- which is a quick checkup to allow a doctor to lay eyes on you and make sure they don't detect anything needing further consultation.
Either we needed more precise legislation covering more, or we needed to convince the companies it was in their interest to make their clients comfortable bringing up signs of illness before it gets worse and costs the insurance companies even more. Sadly, we got neither.
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u/BellaMentalNecrotica 24d ago
That makes no sense. I would think wellness exams would end up saving them money in the long run, no? Let's say the doc determines you have high blood pressure in a wellness exam. Diagnosing it then and getting you on medication to treat it is ORDERS of magnitude cheaper than having it go undiagnosed and ultimately causing a permanently debilitating stroke. Now insurance has to cover all the disability related things resulting from the stroke which could include requiring 24/7 home health when they could have just covered a monthly lisinopril prescription.
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u/SirHippocrates 24d ago
Absolutely, it seems intuitively that it would be in their interest to do so. But they weren't sold on it. Somewhere it fell apart... because if there's a single thing I trust insurance to do, it's to act in their own best interest.
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u/iamacheeto1 24d ago
My insurance shows that I've spent ~$1100 this year on costs that all go to my out of pocket max but not a single dollar went to the deductible.
So I'm going to sign up for the high deductible health plan for next year because I don't see the point of having a lower one when nothing counts towards it
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u/PurpleDiCaprio 24d ago
My former doctors office will charge for an appointment if I have a diagnosis for anything even if it doesn’t get brought up. They charged me for an appointment for lab work that came back AFTER the wellness exam. I took them to small claims court and won.
So I went to a new doctor and they found I had a low heart rate, despite it being very normal for me, and no issues with it, put that as a diagnosis in my chart and billed me for an appointment.
This year I refused to let them take vitals. And made it clear I was not interested in talking about anything unless it was being actively treated.
Going to my wellness exam fills me with anxiety.
Doctor and insurance point fingers at each other.
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u/helios_225 24d ago
If they can't examine your wellness, what's the point of going at this point?
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u/PracticalFruit9506 24d ago
My last primary care “group” would drop you as a patient if you didn’t do your yearly wellness check.
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u/HBJones1056 24d ago
What is even the point of a check up anymore.
“Do you exercise? How much?” (Asked electronically before the appointment, then again by the nurse, then a third time by the doctor.)
“Smoke? Drink? Drugs? If so, how much?”
“Do you feel safe at home?”
“Do you want STD testing?”
Listen to heart, listen to lungs, half-assed breast exam, blood pressure, weighing.
And labs, which is the only worthwhile feature anymore.
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u/pancakeking1012 24d ago
funniest thing is when you get the after visit summary and seeing all the things they didn’t do being marked as done
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u/Pristine-Pirate-2386 24d ago
I stopped bothering with a GP the year they introduced this. There is absolutely no point to having a doctor you can't talk about your health with. There's no trust. Now I just use urgent care or go straight to a specialist. Soooo I'm not sure what my insurance thinks they gained here.
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u/xtal303 24d ago edited 24d ago
I was told the same thing during my last wellness exam. Didn't discuss anything outside of the wellness exam. I ended up getting charged for labs anyway even though the wellness exam is supposed to be fully covered.
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u/--CDXX-- 24d ago
My kid went to have his tonsils looked at, and randomly the doctor says, let's look in his ears with my fancy scope and his asst stopped him, and said "you need to ask his parent, that's a $900 cost".
$900 to look in his ears 😂
Was just going to do it 😂
This fucking country man
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u/RedditUserData 24d ago
They got me with this my last preventive visit. They asked me how a medication I was taking was doing that I had been taking for months now. That question was apparently $150. I asked them to take it off. They haven't responded yet if they are or aren't removing it.
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u/ENrgStar 24d ago
One time during an annual physical I mentioned my toe had a mild infection I thought because a hangnail got infected. They looked at it and asked if I wanted them to pull it and 5 weeks later I got a $500 bill for “foreign object removal”
I could have yanked the hangnail myself
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u/MoeKneeKah GREEN 24d ago
I once went to an appointment with an ENT because I had something stuck in my ear. She looked in my ear, plucked it out with tweezers and asked if I wanted her to look in the other ear. She does, uses the tweezers again, and says we’re done. Whole thing took 20 minutes.
I got a bill a month later for $600 for a “bi-lateral procedure”. I called to ask what I was being charged for since I had already paid the co-pay for the visit. They told me that since she “worked” in both ears, it wasn’t considered an office visit, it was a “procedure” and not covered by my insurance.
I never paid and when they called me to collect I told them “I’ll die before I pay your extortion”. They never called back.
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u/EspessoGriasa 24d ago
Billing six hundred bucks for using tweezers twice takes serious nerve
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u/Emergency-Salamander 24d ago
At least you were told and didn't get a surprise bill, I guess.
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u/lenswipe GREEN 24d ago
shouldn't be getting any bill at all...tf
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u/Icy_Yard_875 24d ago
Obviously lmao, but notifying avout it is the LEAST the could do
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u/Shoehorse13 24d ago
I got slapped with a 35 dollar "smoking cessation discussion" during my last annual physical when I haven't smoked for 25 years. When I called the office to contest it they stood their ground until I asked if I should go to my insurance company to contest the charge at which point they agreed to waive the copay. Such a scam and that will be my last time seeing that doctor.
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u/Elmodogg 24d ago
Folks, just wait until you turn 65. All of this crap goes away when you become eligible for Medicare. It's wonderful. I have a $283 annual deductible, all for a monthly premium (including what I pay for a medigap policy and drug coverage) that is roughly 1/3 of what I used to be paying for health insurance with a $10,000 annual deductible (and no out of network coverage with a crappy network!) when I was under 65. And there's never any thinking about whether a provider is in network or out of network. Other than psychiatrists, nearly every health care provider accepts Medicare (real Medicare, not Medicare Advantage, that is).
Just be very careful not to fall for the scam that is Medicare Advantage. That's privatized and is full of the same tricks and traps as private insurance for people under 65. When you get close to 65 you'll be inundated with ads, calls, texts trying to lure you into picking a Medicare Advantage plan. Don't do it.
Medicare for All is what we really need.
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u/Remarkable-World-234 24d ago
If you bring up anything other than what they code and get paid for, it’s like making another appointment.
My doctor gave me scheduled Botox treatment for headaches but if I wanted to ask a question about my medications, they told me I had to make another appointment. So the doctor who has appointments booked out for 3 months and has more demand than availability’s wants to do what?
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u/sweetfaerieface 24d ago
My husband and I went for our annual physicals last week. We had to sign a thing that we understood that if we talked about anything else we would be charged. Ridiculous!
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u/Blue-martini 24d ago
- "Hi [patient's name], any pain in particular?"
- "On the advice of counsel, I invoke my fifth amendment right..."
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u/K-C_Racing14 24d ago
And the Republicans are running ads scaremongering about losing our private insurance 🙄
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u/Portarossa 24d ago
Apparently losing private health insurance is a lot like losing your virginity: it's only a big deal because society seems set on making it so, the vast majority of people don't regret not having it anymore, and Republicans are WAY too invested in its continuation.
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u/vasta2 24d ago
The best ones are when fox entertainment shows a politicians plans, like AOC, "healthcare for all" like they are trying to scare their viewers into thinking that is bad and will collapse society
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u/curiousobserver2000 24d ago
This is what happens when everyone up and down the ladder is out to make as much money as possible. Add the need to constantly grow revenue each year and you have a recipe for continuous increase in healthcare costs.
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u/eRant4881 24d ago
If you can't discuss health concerns at your annual physical what is the actual point of a physical? Because every other visit and appointment they run the same vital checks to start anyways. So what is the point of annual physical if it is not to check in with your doctor and discuss ANYTHING related to your health regardless if it is preventative, worrisome, new, or pre-existing??? Our healthcare industry is broken, and we are so broken by it that we just accept it...
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u/glassovertheflame 24d ago
This is because of insurance companies 📢📢
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u/Soy_ThomCat 24d ago
Bingo.
As a doctor, I don't want your visits to be confusing or nebulous. I want them to be straightforward and efficient.
Insurance and government says that the wellness (I.e. preventative) exam is only for prevention. So that's what I have to remind patients.
On a personal note, if you have a concern or issue that I can attempt to knock out without the insurance company getting involved I tend to let that slide.
For instance, you come in for your preventative exam and tell me something about how you think your thyroid might be out of whack cuz you're tired all the time? Well that one's easy, I was likely going to test your thyroid anyway, so I can just order thyroid labs with your other preventative stuff and bring you back for a follow up to go over those results.
If you come in with a list of 7 complaints ranging from vomiting blood to shoulder pain after falling off a ladder (yes, those are actual complaints I've had at the wellness visit)... unfortunately my hands are kinda tied here. 1) because the point of a preventative exam is prevention and I'm not preventing much if you're vomiting blood, and 2) insurance companies say I'm not allowed to do both on a single visit.
Yes, I understand that the doctor and doctors office is the face of all these policies so they're the ones we get frustrated with and dogpile...but at the end of the day it's typically not my personal choice or prerogative to make your visits and billing as opaque as possible.
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u/PorkRinds416 24d ago
THIS IS A SCAM CURRENTLY GOING ON. My mom was charged an extra fee FOR SOMETHING THE DOCTOR ASKED HER, my mom didnt bring it up. My mom then called the clinic and the clinic blamed it on the insurance company. My mom then called her insurance agent who works for said company and he said NO, all the insurance does is pay for what the clinic will bill them. Insurance has NOTHING to do with what is actually charged in these visits.
So again, THESE CLINICS ARE DOING THIS TO TRY TO MAKE MORE MONEY AND SCAM PEOPLE. It should be illegal and honestly it pisses me off. Healthcare in the US is already stupid expensive and literally everything is an overcharge.
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u/SadAcadia2747 24d ago
That’s why I don’t do the yearly wellness, bless America 💀
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u/QweenJoleen1983 24d ago
Even if you don’t discuss it, they will add it. Ask me how I know. Once you’re diagnosed with it, you’re stuck.
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u/Kooky_Soft1822 24d ago
America is the terms and conditions capital of the world.
I swear, Everything has an exception or a rule or a contingency clause or some escape clause or some bs.
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u/AmadeusMaxwell 24d ago
So "preventative" means "The doctor's best guess with zero input from the patient"
All insurance is a scam and should be illegal.
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u/AssistanceTypical127 24d ago
It’s absolutely ridiculous. I went in for my physical and the doctor barely looked at me. Was too busy clicking boxes. I asked for a skin check since the doctor missed it on my last exam. Doc came over messed up my hair and did it so quickly I think it was just a charade.
I had a great GP who would talk to me and make sure he had all the info from my specialist. I moved and haven’t found anyone like him since.
I feel like I’m my own to manage my care.
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u/Smuchelle 24d ago
And preventative care includes almost nothing. I used to get multiple blood tests, now I just get glucose and cholesterol. There are many other blood tests recommended for my age group but I would have to look those up for myself and ask and pay for them. The extra money doesn't upset me as much as having to look up everything myself.
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u/dmendro GREEN 24d ago
Pure greed. If it's well exam, than your wellness is pertinent.
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u/mattBK76 24d ago
I experienced this in Atlanta. I was checking in at the doctors and next to me another guy was also checking in. No lie they said to him “if you ask a single question in your physical it’s no longer a physical and you will be charged accordingly”
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u/art_vandelay112 24d ago
In Atlanta as well and I wish I would have heard this. I made a passing comment about my vision to my doc. He does the light thing and refers me to an eye doc. Insurance charged me. Had to fight to get them to change the codes to preventative. Absolutely ridiculous
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u/Blazanar 24d ago
Shouldn't asking any questions about any health issue be classified as "preventative"?
Man I am some fucking glad I don't live in the US
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u/bradmajors69 24d ago
If we're gonna have this ridiculous system, doctor's visits should work like taking your car to the shop.
You are told how much it will cost to have a look at the car. And they give you an estimate before any additional work is done. And you have the option to decide whether to do the work, live with the problem or go to a different shop.
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u/Jchvv11 24d ago
This system was built to benefit shareholders and gouge normal people. Its always been this way its just becoming more glaring now because of the orange baboon and his reign of terror.
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u/spwnofsaton 24d ago
Yeah this happened to me once several years ago. I had gotten surgery recently and later went to my physical and talked about my surgery. I was charged a copay. It’s dumb imo.
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u/fortifiedoptimism 24d ago
Props to them for actually making you aware/reminding you but still a load of bs they even need to.
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u/CraftyOpportunity618 24d ago
I have first-hand experience of this. Once I asked the doctor during routine annual exam if I can lower the dosage on a medication. It was "outside the scope of preventative care", so I was charged the entire amount for the visit.
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u/Conscious_Emu800 24d ago
I asked a question at my well visit once and got charged $200 for it. Ok, I’ll just sit here like a mushroom then.
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u/MizzBStizzy 24d ago
Are you going to my doctor's office or are most of them like this? 😂😭
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u/shaddowdemon 24d ago
I mean, at least they tell you. Most don't. I honestly think they should just get rid of the "free preventative care thing" because the only thing it does is allow doctors to double bill you (if you ask any questions, they charge a normal appointment AND the wellness appointment).
I have migraines, so "can you refill my prescription" means I never get a free appointment.
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u/chgopanth 24d ago
When will we put insurance companies down. They ruin healthcare.