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Which side's fault for my regular preventive exam can not be covered?

edited September 2015 in Obamacare Debates and Opinions Posts: 3
I went into a local clinic on May 4th for my regular physical/preventive exam. During conversation with the doctor, she asked me 3 questions which I can recall that eventually turn out to be diagnoses coded differently so that my insurance company refused to cover. Those questions are: 1) Do you have any changing mole? My answer: Yes. Then I showed it to her, she looked at it and said "That's not even a mole. No worry!" 2) Do you want second kid? My answer: No, because the current one already keeping me busy and tired all the time. Then she said, "Well, then you probably need to check this 'Fatigue' issue by blood draw". 3) Do you have any current problems? My answer: I hurt my foot a couple years ago, and it still bothers once a while. Then she looked and touched and wrote it down in my medical record. Although, the clinic summary showed my visit reason as "encounter preventive health exam", but since all other things wrote as doctor's notes to their coding department, the billing department sent me the full bill eventually. After that, I am involved in these triangle calls among doctor office, financial department and insurance company back and forth. Nobody thinks they did wrong. Then I realized it was my fault to answer her questions. 

Thanks for reading my post. If this is not right place, please ignore or maybe tell me where I can reach any help or any suggestion such as "pay and forget it".


  • Its really sad that if you tell your doctor whats wrong, and you're honest with them, it just comes back to bite you...

    My circumstances are very different, but I learned that lesson, the hard way. The insurance company might actually tell the dr.s to ask those questions just so they can get away with not paying.
  • Maybe my Grandfather had it right. He would refuse to answer any questions. He would say, "you're the doctor, you tell me if there's anything wrong!"
  • Nothing ever goes wrong until you see a doctor, right? Seriously though, you need to treat every doctor's visit as having only one complaint that needs to be addressed. The moment you give them another avenue to pursue they will toss fees at you like crazy. Also, and this may or may not apply to you, there is usually no need to have preventative care unless you are pregnant or at least forty years old.
  • I think that this would be an issue for the doctor's billing department. I would tell them that all you went in for was the preventative care exam, and that you were not aware that the doctor would do anything different. I know this is one of the tricks that we would do when I worked for the eye doctor. We wouldn't always tell the clients that the extra services were extra unless they asked, but it would say it on the form that they had to sign. A lot of people don't read the form before they sign it though, and that's how we got away with it. You have to ask if it's covered by your insurance because that is what I do every time. As a matter of fact, I have to have surgery next month, and the first thing that I asked was does my insurance cover it.
  • It's hard to imagine that your answers affected your billing codes. Doctor's offices have gotten so commercial that it's hard to get a doctor that listens to you before they start thinking about what to note in the chart so that they can get paid. My only suggestion is next time you go for your free annual exam is that you say nothing is bothering you enough to have to pay for your visit. Perhaps that will knock them for a loop. After all if any of those things were issues that you wanted resolved you would have scheduled a sick visit and known that you would have to pay. Scary to think about how much difference a well visit pays versus how much the insurance companies pays for a sick visit. Seems like doctors and insurance companies will find a way to make money off of your health no matter what is going on.
  • I used to work for a Healthcare insurance company. This is 100% your doctor's billing office's fault. Everything is down to how they bill it. If they bill it as a preventative visit, but then bill non-preventative procedures, it's going to be seen as a diagnostic visit("sick" visit). If the diagnosis code isn't preventative, won't fall under preventative. There are so many factors, but it's always down to the way it's billed, unless it was billed correctly and the insurance company changed the codes themselves(not often, but it has happened before). It was not your fault at all, don't blame yourself for this. The doctor's needs to get their billing situated. 
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