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Thanks for the info. I have no problems with copays as we have a Medigap F policy. I understood that there was a deductible and copays with Medicare and that's why we went with a Medigap. I did not understand that they could actually totally refuse to pay for a doc visit.
I actually went to the gyn office today and asked about it. After some checking the woman did tell me that the general visit would usually not be paid for by Medicare, but they forgot to have me a sign a form saying that and therefore would have to write off the $55 cost that Medicare didn't pay for if the Medigap doesn't pay either. I lucked out on that one but will be aware in the future and be careful about what happens at any doc visits. The only things I have happening are arthritis, hip replacement and diverticuli, so not sure any of that would qualify my visits to be paid. I only take 1 Rx med and that's for my back spasms. Everything else is OTC.
Medicare should pay for Gyn visits but on a less frequent schedule. Make sure the office is using the correct codes for preventive visits.
Having insurance is not for routine check ups etc. it IS for when you get SICK or INJURED. It may cover some routine things but that is not the main purpose of Health insurance.
thank you for that. I have always thought too many, think medicare or insurance of any kind should cover everything. That, my friends is called socialized medicine. Most to us, on medicare can remember when insurance didn't even cover a once a year well visit. I am satisfied with what they do and do not cover. No, I have paying for services, I hate paying the plumber for water leaks, but it is a reality. As we age, medicare and our supplements will pay for less tests, etc. As we know, many tests and visits are preventive care and yes, we expect them to be covered. But there comes a time when when, in reality the cost isn't warrented.
This is correct. You either received the limited services provided under the "Welcome to Medicare" wellness benefit and it was coded incorrectly, or you received a more comprehensive annual physical exam and it was coded correctly.
If you received the non-covered comprehensive annual physical exam, you can receive the covered "Welcome to Medicare" benefit later in the year but it still must be within 12 months of Part B enrollment. However, this will push back the date you can receive the next annual wellness visit.
CPT G0402 - Welcome to Medicare Wellness visit. Eligibility - All Medicare beneficiaries within the first 12 months of their Part B coverage effective date. Covered once per lifetime.
CPT G0438 - First annual wellness visit. Eligibility - Enrolled in Part B more than 12 months and not received G0402 within 12 months.
CPT 99396 - Preventive physical exam, age 40-64, established patient. Eligibility - Code not covered by Medicare.
CPT 99397 - Preventive physical exam, age 65+, established patient. Eligibility - Code not covered by Medicare.
Excellent info and totally correct.
One question I have for retirees is what happens when you move to another state after you turn 65, and are starting out with a new doctor in a new location?
Most docs who accept new Medicare patients will want to do a comprehensive "physical exam" that includes touching (i.e., listening to the heart, etc) to become an "established" patient. How do retirees who relocate deal with that? Do they pay out of pocket for the comprehensive "physical exam" when they relocate?
I've not talked to any clinics in new cities where a doctor would accept a new Medicare patient without an initial comprehensive physical exam. Unfortunately, if you wait for a problem to occur, you either end up in the ER or are calling around for a doctor to treat your problem, who has never seen you as a patient before.
I am in my late 60's, already had my "Welcome to Medicare" exam when I turned 65, and now am planning to relocate for the rest of my retirement. Has anyone else had this experience and how did it work as far as finding a new doctor who takes Medicare and the "physical exam?"
BTW, the "Wellness Visit" is just a 5-6 page questionnaire. No touching or it's not covered by Medicare. Dumb, but true.
I'd make my move and work on that issue once settled. It all comes together. Plus if no issues why go to doctor every year or whenever. You know if you are well or not.
I'd make my move and work on that issue once settled. It all comes together. Plus if no issues why go to doctor every year or whenever. You know if you are well or not.
Well, the issue is that doctors in new locations want to have a comprehensive physical exam in order to become an "established" patient. If you have already had the initial comprehensive exam (Welcome to Medicare exam at age 65) prior to moving, Medicare isn't going to pay for another one in a new location with a new doctor. That's the problem. How do you become an "established" patient in a new location with a new doctor without paying for a comprehensive physical exam?
As far as I know, you can't call a clinic anywhere as a "new" patient (who hasn't been seen by anyone at that clinic) and tell them you want to see a doctor for a particular medical issue. They will tell you (I've called and asked) that you first need to be an "established" patient after having a comprehensive physical exam before seeing a doctor for a specific medical problem. Otherwise, you end up in the ER.
I went to a clinic a few yrs ago and paid out of pocket...if you have to go you have to go. That's what a credit card is for. I've been on Medicare for 13 yrs and it's highly abused by many just running to docs for this and that. I'm hearing how the system will be broke in a few yrs. People need to take more CARE of their own health. The former president and his wife were TRYING to instill that in the Americans.
While on Medicare, I moved to a new state. Upon arrival, I had to change my Medicare Advantage plan. Same insurer, new plan for the new state. I then lined up a new Primary Doc, and only paid a $15 co-pay for a "new" patient office visit.
Since then the "annual" visit is $0 co-pay.
I assume if you have only Original Medicare, you would pay 20% of the bill OOP.
If you have Medigap plan, it should cover the 20%.
While on Medicare, I moved to a new state. Upon arrival, I had to change my Medicare Advantage plan. Same insurer, new plan for the new state. I then lined up a new Primary Doc, and only paid a $15 co-pay for a "new" patient office visit.
Since then the "annual" visit is $0 co-pay.
I assume if you have only Original Medicare, you would pay 20% of the bill OOP.
If you have Medigap plan, it should cover the 20%.
I also think as a new patient medicare will pay if the patient has moved to another location, plus doctors can get around this easily by simply saying the reason for the visit was this or that. I agree with jamenhealth, to many people take advantage of medicare.
I am the OP and I can assure you that I don't abuse Medicare or any other insurance that I have had. In fact, I absolutely despise going to a doctor. I do not go for any little thing. I will suffer through minor stuff and only go in for something that is major or won't go away, and then I'm not happy about it. If forced to, I would prefer to go once a year, get all my testing done and my one prescription and get it over with and never see them again until the next year. I originally went to this doc because during a CAT scan when I was in the hospital for diverticulitis they saw something in my uterus. Thought it was a fibroid but wasn't sure and wanted me to have it checked out. He then discovered that I hadn't been to a gyn appt. in about 4 years and insisted that I needed a check-up and testing. I had my mammo done the year before, but never went to the actual gyn doc. Once you get older, though, it is better to discover something early as the treatments for disease are not tolerated as well when you age, as well as being very expensive.
Saying that, I am astounded that Medicare prefers you wait until you are sick rather than go to a doc once or twice a year. It is a known fact that it costs the insurance company a lot less to find something early than wait until it is a full blown disease. I do NOT feel that one physical/year and one gyn visit for women/year is abusing Medicare. Not like we are getting it all for free. My DH and I each pay about $300/month for Medicare/Medigap/Prescription plan, plus all the money we paid into it when we were working. That is a huge chunk out of our income as we don't bring in huge amounts of money per month.
We moved 2 years ago and I picked out a doc but didn't really care for her, so I have been looking for a new one. But now I'm concerned about going because I'm afraid that I'm going to be hit with a huge bill as I know they are not going to accept me as a new patient on a "Welcome to Medicare" visit. I asked the person at the gyn's office if I end up having to pay cash for it can I get a cash discount? Was told no because I had insurance. They would only do a cash discount if you don't have any kind of insurance. So even though it was denied I would end up having to pay the entire amount that they billed Medicare, which is usually more than they expect to get. I absolute hate doctors....and the sad part is that I have a medical background. BS degree in Medical Technology..........BS being the operative phrase.
As far as I know, you can't call a clinic anywhere as a "new" patient (who hasn't been seen by anyone at that clinic) and tell them you want to see a doctor for a particular medical issue. They will tell you (I've called and asked) that you first need to be an "established" patient after having a comprehensive physical exam before seeing a doctor for a specific medical problem. Otherwise, you end up in the ER.
This has not been my experience. I recently self-referred to a specialist and was seen within days, and no physical or comprehensive exam.
Quote:
Originally Posted by rothbear
I am the OP and I can assure you that I don't abuse Medicare or any other insurance that I have had. In fact, I absolutely despise going to a doctor. I do not go for any little thing. I will suffer through minor stuff and only go in for something that is major or won't go away, and then I'm not happy about it. If forced to, I would prefer to go once a year, get all my testing done and my one prescription and get it over with and never see them again until the next year. I originally went to this doc because during a CAT scan when I was in the hospital for diverticulitis they saw something in my uterus. Thought it was a fibroid but wasn't sure and wanted me to have it checked out. He then discovered that I hadn't been to a gyn appt. in about 4 years and insisted that I needed a check-up and testing. I had my mammo done the year before, but never went to the actual gyn doc. Once you get older, though, it is better to discover something early as the treatments for disease are not tolerated as well when you age, as well as being very expensive.
The key, in my experience, for getting new patient appointments is to go for a specific reason, not a routine exam. You say you had suggestive imaging results, not that you haven't been to a gyne in four years.
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