Medicare “wellness visit” and breast cancer.

Posted by sandyjr @sandyjr, Mar 7 7:44am

As a two time breast cancer survivor, I am proactive with medical issues and want to find any problems before they become huge. Since I am a BC survivor, I am putting this information under this heading, but it applies to all Medicare patients. Here is a Medicare “Wellness Visit” story for you. I called my doctor yesterday to make an appointment for a yearly physical. I kept my government insurance from my job which I pay a tidy sum for. I am entitled to one yearly physical per calendar year. So when I told the young lady that I wanted to make an appointment for a yearly physical, she said I could not make one yet because the last time I had a wellness check was in October of last year, and I had to wait a year from that. I explained to her that I did not want a wellness check but I wanted a yearly physical. So we went back-and-forth a bit and she said hold on and went to talk to somebody. Later she told me that the doctor was listening to the conversation. I tried to explain to her that Medicare is my primary and that I have a secondary insurance and not a Medicare supplement. Well, apparently no one there knows anything about how that is handled. Anyways, after the scheduler had to get instructions on how to handle my request a couple of times with the doctor listening this is what I was advised to do. Apparently the doctor said he would be glad to see me in October which would be a year from my last “wellness visit,” but if I wanted a yearly physical, which Medicare does not pay, for I would have to fill out the form, which I am well aware of. This is a Medicare form that explains that they do not pay for the service and I would be responsible for the full fee, but that I would also have to pay a surcharge for him to give me this exam. My last "wellness visit” consisted of the list of questions that they ask you, as well as I told him I was having pain in my thumb and he looked at that. He never listened to my heart looked in my ears or anything. The nurse had taken my blood pressure and weight. Medicare was obviously charged for the wellness visit and also an office visit. My Blue Cross Blue Shield was charged for the office visit. I do not think that they were charged for the wellness visit because that's Medicare thing. I would have to double check. So it appears that this Medicare wellness visit is really being pushed by the medical professionals. Friends have told me that their doctors offices are calling them to be sure to schedule the “wellness visit.” Easy money for them because apparently they don't have to do anything but ask a series of questions that are themselves questionable. So unless you have your own insurance and you are over 65 and on Medicare, you can't get a physical unless you pay out-of-pocket. What kind of treatment is that for people that obviously need to be checked over by a doctor? I don't know if it'll do me any good but obviously I will be changing Drs.

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breasttumor2 | @breasttumor2 | Mar 7 9:16am

A lot of work! I feel for you...i would def call medicare support and tell them your horrible appt incl. Dr. listening in and tell them you want a new dr. and when u get one ask them b4 u go to appt. What their office's procedure is for your dilemma. Dont forget 2 write down names, dates-even 4 the receptionist who takes ur call...

Chris, Volunteer Mentor | @auntieoakley | Mar 7 10:33am

When the office called to schedule this for my husband this year. I declined to schedule it, explaining that it hasn’t really provided a benefit for him and that I would gladly schedule an actual physical instead. They called me back and scheduled a physical.
Sadly you might have to wrestle an actual physical out of this. They are kind of a thing of the past.
I for one don’t really mind as I abhor being touched by strangers, but I understand the sentiment.
Have you tried talking to the office staff face to face about this? Have you applied for care elsewhere?

windyshores | @windyshores | Mar 7 3:45pm

I thought the Medicare wellness and physical were the same thing. And you are not allowed to do anything diagnostic in them. Only talk about prevention. You can go in the next day if you want, to discuss a specific problem and diagnosis or treatment.

lifetraveler | @lifetraveler | Mar 8 3:09pm

Hi! @sandyjr:

I am so sorry that this unfair & unpleasant experience happened to you! Not sure whether my personal experience would help, because our health insurer probably is not the same; but the similar situations "almost" happened to me last year. I got an email from my insurance company (out of the blue) reminded me the importance of getting annual physical exam and medicare wellness check for preventive care. So I called the office of my PCP to schedule them accordingly. The scheduler declined to schedule them - just like the similar reason that they declined your request. Knowing that my PCP is a very kind and caring lady doctor, for she has been taking care of me for more than 2 decades, I assumed there must had been some misunderstanding somewhere. So I decided not to argue with the scheduler (because she obviously did not know the correct insurance policy) and called the member support of my insurance company. They assured me that "annual physical exam" and "annual medicare wellness check" are different PCP office visit thus providing different purposes for the well-beings of elder folks like us. I explained my difficultis of scheduling with the office of my PCP, and the customer (member) support of insurer made a 3-ways telephone call to the office of my PCP and thus cleared out any misunderstanding. As I've been informed: it is the patient's right to have one physical exam + one medicare wellness check per calendar year; the scheduler simply needs to enter different "code" when they fill out the billing form to be submited to the health insurance company of the individual member.

I am sorry for such a lengthy note, hopefully it may help. I simply wish to ease your pain in some ways...

Best wishes to you all for a healthier and happier journey ahead!