Confusion and frustration during a PCP visit.

My wife, daughter, and I all scheduled a visit with our new PCP when we were finally able to get health insurance. This is in North Carolina. 7 months later we finally get to be seen for our first intake visit. During this visit we see the PA who takes our heights, weights, and BP, and then reads off from a questionnaire about what our future health concerns are. Plan says all preventative care at PCP is $0, no copay, deductible does not apply.

For me I talked about ADD and she told me I didn’t need a referral, and I should go to wherever and do the thing and come back for a physical. All well and good. My visit was covered by insurance under the $0 PCP visits. My daughter same same, all covered. My wife mentioned anxiety and asked about weight loss medication out of curiosity. The PA said she would send “test scripts” to see if our insurance would cover a certain medication and that she should get a physical and they would go from there at the next appointment.

At no point did anybody mention we would have a copay until the end of the visit where they tried to charge us for everything. After arguing and getting insurance on the phone, they agreed we were indeed covered for the entire visit. Annoying, but great. We’re “good to go”, and leave.

2 months later we get a bill. Her visit was not covered. The insurance company says she was treated for anxiety. She mentioned it, they checked a box, did not prescribe anything, did no tests, took no blood, asked no follow up questions. The doctor’s office says no, she was treated for weight loss. I was under the impression we were just discussing future health concerns with our new PCP, and it would be covered. Doctor’s office insists that regardless of our coverage, we will always have to pay something when we go to the doctor.

I mean, am I just an idiot? I’m a janitor, I can’t make heads or tails of this insurance stuff. Am I to assume at any point during a standard check up if you say the wrong thing, you can be charged for treatment even if they don’t do.. anything? Like if she was treated for weight loss wouldn’t they have like.. taken blood? Checked her BMI? Made recommendations for dietary changes or done.. anything? Why is the code for the insurance different than what the doctor’s office is saying was done? Why didn’t I get charged for bringing up my mental health concern, but she did?

Thanks for reading.