When "free wellness check ups" aren't

[Paula Sims]

First of all, a disclaimer: I am NOT against the ACA and support it in so much as it's a first step toward single payer. However, we REALLY need single payer. . .

I just got a co-payment bill (granted, only $15) from my doctor's office. I called to ask why since I thought annual physicals are supposed to be free. Well, per ACA rules (although I do have to double check with my insurance company), the patient can't talk about "ongoing concerns" or they'll be charged for a full visit. So basically, I have to go in, get my vitals, say this is a wellness check-up, and just shut up. I have to wait for the doctor to tell ME that my arm has dislocated. I can't even say -- geez doc, why don't you have me try to rotate my arm?

I'm not heartless to those that work for insurance companies as they need jobs too -- I'm heartless to the insurance executives that aren't getting as many billions this year as last year, or to the mega-merger hospitals that guarantee private rooms with two TVs in each room. And frankly, I'm a bit peeved at my doctor, but that's for another post.

Again, I'm not complaining about the $15, I'm complaining about they way even my employer posts: annual wellness checkups are fully covered with no copay or deductible.

Come on single-payer!

[truedelphi]

1. Do you really think that now that we have mandated premiums against

Every man woman and child, and all those additional premiums will further enrich the Big Insurers, that they will be spending less money to make sure we never ever have Single Payer Universal HC?

I have never followed the logic of those who say that the ACA is a start.

[jeff47]

3. It's a start because it moves the battle to the states.

Getting a public option or single payer passed in a "blue" state is easier than getting it passed nationally. Because Congress over-represents red states.

Once we get a few states working with single payer, or de-facto single payer via public option, it'll be much easier to fight the national battle.

[pnwmom]

7. Yes. And Colorado is trying to get single-payer through right now. n/t

[still_one]

2. You should not be charged a co-payment for an annual wellness visit. Unless you are on one of the

Grandfathered plans, or you had your physical done through an out of network visit

However, depending on your insurance, if the doctor who performs the physical actually don't Es some treatment you can be charged a co-payment for the treatment portion. If the doctor refers the patient to a specialist, the preventive care visit should not require a co-payment

[Doctor_J]

4. The ACA is not a first step toward single payer

It will have to be undone for sp to happen. It baked hundreds of billions of dollars in profits for the insurance companies into the cake, and put the burden on people who work at small companies. It mandates that we all contribute to profits for a private industry that provides nothing except impediments to actual healthcare.

[pnwmom]

8. Not true. ACA funds can be used in the states for a single payer system and Colorado

is trying to set up a system right now.

[hill2016]

10. that's not true

the insurance industry accounts for about $100b+ a year out of $3t of annual health care spending.

Of this, most of it goes to "work" (claims review, underwriting, compensation, marketing, etc.). The remainder of course is profit.

[obnoxiousdrunk]

5. Could it be

that you're last wellness visit was less than a year ago ?

[tammywammy]

6. Yes, preventative wellness exams are covered but ongoing issues would not be.

My doctor's office gives a sheet explaining this when you arrive. They can only code certain things as part of the wellness visit. For instance, my vitamin D level is checked every year, but that is not covered as part of the free wellness visit, I get charged separately for it.

On-going issues are not considered part of a preventative exam.

The HHS ACA website lists exactly what is and isn't covered as part of preventative care.

[Glamrock]

9. I think we'll get there

By necessity. The whole system is fucked up.
For example, couple years ago I had a fall. Bounced my head off a step rail on a pickup truck. Woke up on the ground....in a pool of blood. Awesome. After waiting in the E.R. lobby for 45 minutes with a headwound (FFS), I was seen too. Almost. I waited another 15-20 on a bed. Nurse came in checked vitals. Waited another 20 for doctor. (At this point I'm wondering if I could legally bill the hospital for my time, but I digress) Spent all of 20 minutes with the doctor and got 4 stitches. And here's the point. The bill for 4 stitches was somewhere between 2 & 4 grand! I was on a bed for 40 minutes. I took up 10 minutes time from a nurse and twenty minutes from a doctor. There was also the thread and needle. Oh and the plastic biohazard gaurds on the thermometer, etc. Thousands of dollars? Thousands of dollars? Really? I do remember that, for some reason the hospital had me down as uninsured. The bill was higher for me than it was for the insurance company (once the insurance kerfuffle was straightened out). The doctor's portion dropped $200. From $800 for me to $600 for the insurance co. Are ya fuckin kiddin me man? That's between $1800 & $2400 an hour! Insane. This crap just ain't sustainable. It just. ain't. sustainable.

P.S. I'm in Indiana. Know a lot of Republicans, or conservatives, or libertarians, or whatever they're calling themselves today (Loved when they were calling themselves teabaggers.:LOL ) Whenever Obama care comes up, I'll tell them I wanted a public option. To buy into medicare. So far they've all agreed. Every one of them. Not a one has turned white and screamed SOCIALISM! BAD! So, yeah I think we'll get there. Won't be easy, but I think we will. Just my 2 cents.

[hill2016]

11. you're not just paying for the doctor's time

you're paying for all the overhead, administrative costs, cost of capital expenditure, and of course for the medical care for the uninsured that the hospital absorbs.

[Glamrock]

12. I get that, I really do

But no one can convince me that 2 or 3 or $4000 for a few stitches is justified. Nor can anyone convince me that we can continue on in this way indefinately. But, your point is taken.

[cvoogt]

14. and the profits

.. don't forget the profits. After all, capitalist health care has to answer to shareholders first.

I got some stitches in my head in the Netherlands once. Went to a local doctor, no insurance, just paid cash. Two stitches cost me under 50 euros, total. Paying out of pocket. Procedure took all of ten minutes. Just saying.. it doesn't have to be the crazy setup that it is in the US.

[LibDemAlways]

13. Yep. Thank God for Medicare. My 92-year-old mother

recently had a fifteen minute outpatient diagnostic procedure performed at a clinic. When the bill came, I had to sit down. $12,000. You read that right. Of course the clinic can charge whatever ridiculous amount they want, but Medicare paid $600.00 and the balance was written off. Imagine not having insurance and being hounded by a debt collector for the full or close to the full amount.Not sustainable. Agreed.

[dixiegrrrrl]

15. I have single payer. And the same problem

Medicare allows one annual eye checkup.
Deductible per year for Medicaid is 147.00.
co-pay is 20%.
Thus if I do an eye exam in the first 6 months of a year, I basically pay for it myself, assuming I have not had any other medical charges which ate part of the deductible.
My normal routine is annual medical visit for prescription renewal, in August, office visit is 100.00.
( it was 50.00 until ACA hit, then it zoomed up)

If I want to see the eye doc more than once a year, I have to cite an ongoing eye problem as a reason.
But the 20% still applies.

And Medicare only pays for single vision lens and one frame, the cheapest one.
( buying glasses on line is extraordinary cheap and works very well, I find.)