Annual Physical VS Office Visit
I live in MA and have Blue Cross Blue Shield HMO.
I am beyond confused. I had my annual physical back in February which was the quickest, most uneventful visit I've ever had. I left feeling like wow that was easy. No referrals, didn't need blood work, etc. A few weeks later I get a bill for a copay for the visit. I couldn't figure out why but was told I was a physical and an office visit because we discussed something that was outside of preventative care, at the time I didn't want to deal with it so I just paid the copay.
Upon further reflection I realized I don't know what we discussed that would constitute it as an office visit. I contact the office to inquire, they tell me it had been coded as an office visit because we discussed things outside of normal routine care. The woman lists off three items that I "discussed" with the doctor: ANXIETY – this is not a new condition and has always been on my charts and I'm treating it. It was not discussed further than that I filled out the questions on anxiety and was, guess what, found to have anxiety. But this is not new information and already was in my records. Second was a condition that I had a referral for last year from this same doctor and she asked "how is this" and I said yes it was dealt with and fine now. The third was "itchy scalp", which I only mentioned after I was asked "is there anything you'd like to ask me?" and was recommended over the counter medicated shampoo.
I've never had an experience in my adult life being charged for an office visit at my physical except last year with this doctor and now this year. Last year at my physical I received two referrals so I thought that made more sense. This recent visit was coded as "diagnostic" for two items which were already on my record, and seriously… itchy scalp? With literally no physical exam?
As I'm looking into this, I find my insurance claim doesn't even list that a physical was part of this at all. I was billed for only an office visit or "diagnostic" visit. So there's not actually anything that I can find saying this was even a physical, because according to the insurance I did not have one. When I called the office, the receptionist had this attitude like it was the insurance's fault and they deemed this as outside of a physical when they look at the visit. But insurance is like the office submitted this claim as just an office visit. I'm in no way trying to say the insurance companies are saints, but in this case it's very black and white. My doctors office has to code it this way, but not even mentioning it was a physical?? Plus listing three items as diagnostic when two were pre-exisiting?
The health care system in the US is so confusing! I'm 32 years old and I've never had to pay for office visits from asking my PCP a general question like "my scalp is itchy". I've always been under the impression that your annual physical was the place to bring up any questions or issues you've been having. I can get if there was some sort of actual test or additional exam, or any form of additional work, but as I said, this was such a quick visit. I've had plenty of questions in the past and not been charged! My doctor also did say at the beginning of the visit, you are here for your annual physical, correct? But she never has mentioned to me that by asking a question I am going outside of that and now this is an office visit, so how am I supposed to know that? It almost seems like baiting to ask if I have an additional question, if by me having an additional question charges me? I've also looked at my insurance information and to be honest, cannot make sense of what actually qualifies as part of an adult annual physical because it's massively vague!
Is the fact I have anxiety not "routine" and so the mention of it, from my doctor, now means I do not get to use my supposedly covered by insurance annual physical exam?? Is it truly because my doctor recommended I try an over the counter shampoo that this became not an annual physical??
submitted by /u/opossum_qween
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