I’ve always been good about going in for my annual checkup, both when I was working and now 7 years into early retirement. I was blessed to work for MegaCorps that had on-site health clinics and executive health programs, that made it easy.
I recently went in to our post-retirement clinic for my annual check up and was surprised to get a bill for $278 afterwards. I thought checkups were supposed to be “free” – that is, provided as no additional cost under the terms of a basic health insurance policy?
It turns out that because I asked the physician’s assistant to look at a spot I had on my shoulder, I was billed an exorbitant fee. The spot – as I had previously been told – was just a common & benign thing called “Seborrheic Keratosis”. She confirmed the previous diagnosis in 15 seconds, but because specifically I asked about it … cha-Ching! The whole appointment became “elective” and billable.
I guess it’s no surprise that I’m not the only one who has been shocked to be charged for what they thought was a simple “preventative” visit.
A Vox article I recently saw suggests people go as far as asking, “Can we keep the conversation limited to what the billing department would consider a preventative visit?”, at the start of your appointments. Otherwise, you are vulnerable to have a simple question turn into an unneeded medical expense by the billing department.
I’m about 30 days into fighting the bill. The billing department is dragging their feet and claiming they don’t have all of the needed information yet for an appeal. Their expertise seems to be in waging a long, administrative war of phone & letter attrition with their customers. Nice.
Have you been surprised to have a preventative exam turn into a billable visit?
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MrFireStation 
It’s called ‘up billing’ or ‘up charging’ and yes, it happens to me and everyone else. When you go to the Doc you have to ask them if you are going to be charged for a question, typically the Doctors don’t know either, this is just one of the many ways health insurance companies make their profits. Your lucky it’s under $300 and that you have the $300. It’s why I dumped Health Partners and let United steal money from the Federal Government via my Advantage Plan.
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It looks like my healthcare network lost $378M last year on $4.9B in revenue and down graded by Moody’s. No wonder they are “upbilling” me … they are scratching to be solvent.
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Their POV: Client initiated “change order.” Addition accommodated and charged.
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my insurer just keeps profiting, Biden is reigning them in, they have just two more years to bilk the Medicare budget — after all it will take the poor souls a couple of years to stop stealing from the taxpayers.
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All Minnesota health insurance companies are non-profit (by law), aren’t they?
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Do your research 🙂
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took me one minute t o find this, from 2017 — are you getting outdated 🙂 https://www.twincities.com/2017/02/03/new-law-lets-for-profit-hmos-into-minnesota-the-last-state-to-keep-them-out/
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Chief, for all things in life, follow the money. From your view, it’s just adding an extra look-see to an annual wellness visit. No biggie, you’re there anyway. But your post indicates you may not have asked your question if you had known it was not “free.” From their view, all work is billable to some party who will pay. No biggie, they’re there anyway. Any extra question adds extra procedures which must be examined, diagnosed, documented, and invoiced. Each of those steps requires expertise and time applied to patient’s request. That costs money. Regs tell them how to bill it. Aligned incentives on their end gain maximum revenue from minimum investment of time and effort. It’s how business works. When business-as-as usual changes to customarily providing “freebies” to requesters, work goes up and profits go down. That is a big factor in why ad agencies have become struggling business entities for decades.
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Corollary1: If you add up all the time you’ve invested over 30 days fighting $278 bill, how much per hour are you paying yourself IF you “win”? Would you ever work for that payout at such paltry wages? Even “moral victories” come at a life-value cost.
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Agree that the juice needs to be worth the squeeze. I “charge” myself $100/hour for issues like this. That gives me about 2.8 hours to solve it. I’m not near that yet, but am always mindful of how much time I’m investing. https://mrfirestation.com/2020/05/18/12881/
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I definitely wouldn’t have asked the question had she told me it changed the nature of the check-up to be chargeable. I just wanted her to look at something my previous doctor had looked at on his own. That doctor left the clinic – maybe he wasn’t hitting his quota!
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health care doesn’t work well in a for-profit business model because people die. I’ve had annual wellness exams since birth. It’s always been customary for my Doc to ask me if anything is new. About 25-30 years ago, I thought I was healthy so just brought minor complaints — which was a regular part of my annual wellness exam. The idea being if you catch things early, before they become serious health issues, its a win-win. Patients stay healthier and insurance companies therefore pay out less. To my surprise, I had a vitamin D defenciency — so I’ve been taking 7000 iu’s of Vit D all these years. No I was not charged for this new discovery. and no I have not had any major health issues due to my vit d deficiency — win-win! Now, things have changed and we have for profit health care and insurers like short-term profit, they could care less if we are healthy or not. Today, people are charged for bringing up anything new, so they don’t. Later on insurance companies can rake in the profits off of the higher medical bills that will occur.
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Corollary 2: I’ve learned at standard scheduled medical exams to stick to their computerized lists of what and how to inquire and examine patient. It’s a factory run. If in answering their queries to me, they open a door (“is there anything else you want to ask?”), I’ll proceed with caution (“Well, as long as you ask…”). Cat & mouse game.
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Yes – “anything else?” seems to be the ultimate soft sell.
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The last small business I worked for had an insurance broker that really went above and beyond. She came into the office and gave an educational class on exactly the topic of upcharges AKA surprise billings. For background, she told us that medical groups sign up to be a part of a PPO (Preferred Provider Organization) and in return for providing their services at reduced rates, they receive a steady stream of patients and an income that covers their mortgage. So far so good.
But often the medical groups miss the “fee for service” that they receive for non-PPO patients. So they try to double dip and have it both ways. The agent explained that these bad actors will send you a bill with the hope that you will pay it despite it being outside the terms of their contract with the insurance company. She told us to contact her, if we get any surprise bills and she would fight back on our behalf. I recently helped my middle son sign up for insurance at his work, and as a part of the process viewed a presentation about the plan options. His agent also told his insurance customers to contact him and his team to handle surprise bills.
Equipped with the knowledge that medical providers try to double dip into both PPO and Fee for Service, I came up with my own process for getting rid of surprise bills. I send a letter to the Medical Group / Doctor that documents that I have paid the agreed to copay and if they feel that did not receive the proper amount for the service they provided, then they need to take it up with the insurance company. I always end the letter by explaining my payment in the context of the Obamacare Law and my next step will be referring this to the California Department of Insurance. Your state will have the equivalent.
I have never had a surprise billing creep up as a part of a “Preventative Healthcare Visit.” I have had two similar experiences for Emergency Room visits with Ambulance Services for much larger amounts. In both cases my letter got the job done as a one and done proposition. In both cases I never heard from the ambulance provider or doctor again.
If a doctor tried this with me, I would look for a new doctor who isn’t a double dipper.
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Another comment from a fiscal conservative praising The Affordable Care Act, aka Obamacare. No judgment, only an observation.
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I still dislike Obamacare, because it caused my health insurance rate to double. Prior to Obamacare, I bought health insurance that was rated based on health and lifestyle similar to life insurance and because I take good care of myself, I could buy it at half the price. I learned to play the game to get what I am being forced to pay for.
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Those are the kind of insurance agents you need to have. I’m in good old MegaCorp insurance now and wouldn’t even know who my agent is. Laws on these preventative check up’s are starting to change. Watch for my Friday post.
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Yes, on paper for-profits were allowed into MN starting in 2017, but it was structured in such a way that none of them actually came into MN in any material way. UHG tried in 2019 with a State Contract for Medicaid patients, but it remains a token effort. According to the Strib, the 7 health insurance companies that dominate MN are all non-profits. Which clinics do you use?
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