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Old 09-19-2019, 12:07 PM
 
Location: Scottsdale, AZ
8,517 posts, read 5,245,516 times
Reputation: 31410

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Posting this for informational purposes. No burning question.

I tried to schedule a colonoscopy with my multispecialty clinic back in California. They informed me I would need to have a physical first. OK, fine. I scheduled it. Only they coded it as a Medicare Annual Well Visit, which is NOT a physical. I did not know that then.

When I arrived this am for the appt, I was told, "Your Medicare is Inactive." And they blew me off. I traveled 750 miles for this?

I called Medicare. My coverage is Active, has never been INactive. I've paid about $4,000 in premiums and envy taxes (aka IRMAA) since enrollment late last year. I have yet to get any actual health care due to bureaucratic screw-ups.

However, the Medicare rep said that I didn't qualify for an Annual Well Visit, since that can't happen until a year after my Part B coverage became effective. So not until 2/2020. And again, it isn't even a physical. But the clinic coded the visit as an AWV anyway. You can guess why: A sure and certain reimbursement from Medicare without having to chase down payment from me. (Medicare doesn't cover physicals.)

But my coverage is Active. The clinic still says it isn't. I have two more appts with them, both of which I will have to cancel. And I was supposed to get a referral for a cardiologist, which won't happen now.

If anyone has a reliable health care provider in the PHX metro that knows their posterior from a hole in the ground when it comes to Medicare, please let me know. I'm leaning towards HonorHealth Scottsdale Shea because it's close to my home but I'm willing to drive further. Thanks.
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Old 09-19-2019, 12:14 PM
 
Location: SoCal
14,270 posts, read 6,870,254 times
Reputation: 11089
A well visit is exactly that, you have to be well to go for a visit. I’ve been trying to lose weight and keep my numbers well in the range before I go to see my PCP for a well visit. I don’t want my doctor to be an alarmist. You are not missing much.
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Old 09-19-2019, 12:26 PM
 
2,514 posts, read 1,283,888 times
Reputation: 10426
Sounds like you're having communication issues, and you need to sort them out.
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Old 09-19-2019, 12:28 PM
 
73,728 posts, read 73,563,215 times
Reputation: 51270
Quote:
Originally Posted by NewbieHere View Post
A well visit is exactly that, you have to be well to go for a visit. Iíve been trying to lose weight and keep my numbers well in the range before I go to see my PCP for a well visit. I donít want my doctor to be an alarmist. You are not missing much.
A well visit is not the same as a physical.....a well visit is more like a consultation that plans a strategy out for the year ....
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Old 09-19-2019, 12:55 PM
 
Location: SoCal
14,270 posts, read 6,870,254 times
Reputation: 11089
Quote:
Originally Posted by mathjak107 View Post
A well visit is not the same as a physical.....a well visit is more like a consultation that plans a strategy out for the year ....
Who knows what it is. I used to see him once a year which physical check up, but I believed I paid the copay. This well visit is free. I take it. I just have to see him occasionally otherwise I might not be his patient anymore.
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Old 09-19-2019, 12:58 PM
 
73,728 posts, read 73,563,215 times
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Quote:
Originally Posted by NewbieHere View Post
Who knows what it is. I used to see him once a year which physical check up, but I believed I paid the copay. This well visit is free. I take it. I just have to see him occasionally otherwise I might not be his patient anymore.
it really is more of a free consultation ... i never even bother ...we just have annual physicals every year , complete with co-pays
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Old 09-19-2019, 01:02 PM
 
Location: SoCal
14,270 posts, read 6,870,254 times
Reputation: 11089
Quote:
Originally Posted by mathjak107 View Post
it really is more of a free consultation ... i never even bother ...we just have annual physicals every year , complete with co-pays
He does listen to my heart rate and everything, except for the gyn exam. He used to do it, I forgot why he doesn’t. No more urine test either.
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Old 09-19-2019, 01:10 PM
 
73,728 posts, read 73,563,215 times
Reputation: 51270
here is what the free wellness exam allows

services and whether Medicare will pay for them.

What it is
This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including these:

Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
Height, weight, and blood pressure measurements.
A calculation of your body mass index.
A simple vision test.
A review of your potential risk for depression and your level of safety.
An offer to talk with you about creating advance directives.
A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.
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Old 09-19-2019, 01:10 PM
 
Location: Scottsdale, AZ
8,517 posts, read 5,245,516 times
Reputation: 31410
Quote:
Originally Posted by NewbieHere View Post
He does listen to my heart rate and everything, except for the gyn exam. He used to do it, I forgot why he doesnít. No more urine test either.
They must be all stocked up on urine, then. Or some urologist is done lining his root cellar with filled specimen jars.
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Old 09-19-2019, 01:17 PM
 
Location: Scottsdale, AZ
8,517 posts, read 5,245,516 times
Reputation: 31410
Quote:
Originally Posted by mathjak107 View Post
here is what the free wellness exam allows

services and whether Medicare will pay for them.

What it is
This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including these:

Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
Height, weight, and blood pressure measurements.
A calculation of your body mass index.
A simple vision test.
A review of your potential risk for depression and your level of safety.
An offer to talk with you about creating advance directives.
A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.
To me, itís less about what Medicare pays for and more about the clinicís fundamental dishonesty. If they schedule me for an AWV instead of the physical they claimed was mandatory, thatís just profiteering.
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