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Old 01-11-2018, 11:02 AM
 
45 posts, read 67,142 times
Reputation: 57

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Did you know this?

ALL BCBSSC plans cover *preventive* services, as required by the PPACA, but not a "complete" physical. By complete physical or annual exam, in which ongoing medical problems are addressed or prescriptions are renewed, or in which one or more complaints are evaluated and treated.

I keep getting surprised by this and charged multiple "office visits" for the same visit. This is why. I caution everyone to review services with your provider before your visit to be sure no surprise bills are received thereafter, not covered by insurance.
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Old 01-11-2018, 11:31 AM
 
Location: Coast of Somewhere Beautiful
2,320 posts, read 4,596,854 times
Reputation: 5710
Are you on Medicare? Medicare does not cover annual physicals, only an "annual wellness check", which is a very different animal. Since Medicare does not cover a physical, no Medigap plan, regardless of provider, will cover it. I have been told that some Medicare Advantage plans cover a physical but don't know about BCBS.

Sometimes it's all in the coding. Medicare will not cover a physical but will cover an extended office visit, where tests are conducted to monitor existing conditions or to help diagnose potential conditions. Not much difference between that and a physical. Talk to your physician; many of them are sympathetic to the current chaotic nonsense that's called insurance.
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Old 01-11-2018, 11:39 AM
 
45 posts, read 67,142 times
Reputation: 57
PawleysDude: Chaotic nonsense is right!!!

Unfortunately NONE of the BCBSSC plans cover a complete exam (I simply needed a refill of prescription). I called today to ask - in case there was another plan to choose. There is not. I am on Business BlueEssentials.
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Old 01-11-2018, 11:45 AM
 
Location: Gray Court, SC
2,986 posts, read 2,145,531 times
Reputation: 3111
Quote:
Originally Posted by bradlm View Post
Did you know this?

ALL BCBSSC plans cover *preventive* services, as required by the PPACA, but not a "complete" physical. By complete physical or annual exam, in which ongoing medical problems are addressed or prescriptions are renewed, or in which one or more complaints are evaluated and treated.

I keep getting surprised by this and charged multiple "office visits" for the same visit. This is why. I caution everyone to review services with your provider before your visit to be sure no surprise bills are received thereafter, not covered by insurance.
Been like that for a while now.

Oh, and its not just BCBSSC. Im have BCBSTN with my wifes work, and hey wont cover them either.
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Old 01-11-2018, 12:35 PM
 
1,779 posts, read 757,557 times
Reputation: 3217
Go back to your doctor's office. If this is an annual exam and they are only giving you a refill for your long term prescription then they are coding things incorrectly. Have them resubmit with proper codes. If you are going in for an exam and then saying hey doctor I have this problem then you are the cause. Discuss that problem at another time, checking your insurance to see if they partially cover going to the doctor for problems as some insurance covers annual exams and then gives you 2 or 3 office visits with a copay. See this article https://www.usatoday.com/story/money...llet/14111689/
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Old 01-11-2018, 06:57 PM
 
Location: Greenville, SC
264 posts, read 156,600 times
Reputation: 220
Quote:
Originally Posted by bradlm View Post
Did you know this?

ALL BCBSSC plans cover *preventive* services, as required by the PPACA, but not a "complete" physical. By complete physical or annual exam, in which ongoing medical problems are addressed or prescriptions are renewed, or in which one or more complaints are evaluated and treated.

I keep getting surprised by this and charged multiple "office visits" for the same visit. This is why. I caution everyone to review services with your provider before your visit to be sure no surprise bills are received thereafter, not covered by insurance.
A "complete physical" as you describe above is not considered a preventive service. It is considered a diagnostic service and would be subject to whatever your benefits are for diagnostic services. This is not unique to BCBSSC. It is across the health insurance industry. Also, use of the term "covered" is a very misunderstood word in health insurance. Covered means the claim will be processed according to the benefits for the service you received. Not covered would be a claim completely denied with you owing 100% of the billed amount of the charges by your healthcare provider. Example would be a service you had done that would be subject to your deductible before insurance pays. Even though insurance didn't cover the cost at 100%, it is still "covered" because the claim processed correctly according to your benefits for that particular service.

Your advice about checking with your health care provider is spot on. Remember to also have a clear understanding of the insurance plan you are on. I obviously work in the industry and I'm shocked at how many people do not research their health insurance before making a decision.

As for employer based plans, simply put, your plan is only as good as your employer wants it to be. Most employers now choose what's called self-funded plans which means the employer pays all claims, prescriptions, etc. They just hire the insurance company to administer their plan and pay the insurance company a monthly admin fee based on the amounbt of employees enrolled in the plan. In the employer based system, employers have a tremendous amount of control over your level of coverage.

Hope this helps.
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