{"id":1923,"date":"2023-10-30T09:02:55","date_gmt":"2023-10-30T09:02:55","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=1923"},"modified":"2023-10-30T09:02:59","modified_gmt":"2023-10-30T09:02:59","slug":"when-that-supposedly-free-annual-physical-generates-a-bill","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=1923","title":{"rendered":"When That Supposedly Free Annual Physical Generates a Bill"},"content":{"rendered":"<div>\n<p>Christine Rogers of Wake Forest, North Carolina, didn\u2019t hesitate when she was asked to fill out a routine mental health questionnaire during a checkup last November.<\/p>\n<p>Her answers on the form led her primary care doctor to ask about depression and her mood, and Rogers said she answered honestly.<\/p>\n<p>\u201cIt was a horrible year. I lost my mom,\u201d Rogers said she told her physician.<\/p>\n<p>After what Rogers estimates was a five-minute conversation about depression, the visit wrapped up. She said her doctor did not recommend treatment nor refer her for counseling.<\/p>\n<p>\u201cIt\u2019s not like anything I told her triggered, \u2018Oh my goodness, I\u2019m going to prescribe you medication,\u2019\u201d she said.<\/p>\n<p>Then the bill came.<\/p>\n<p><strong>The Patient:<\/strong> Christine Rogers, 60, a public relations\/communications worker who is insured by Cigna Healthcare through her job.<\/p>\n<p><strong>Medical Services:<\/strong> An annual wellness visit, which included typical blood tests, as well as a depression screening and discussion with a physician.<\/p>\n<p><strong>Service Provider:<\/strong> WakeMed Physician Practices, part of WakeMed Health &amp; Hospitals, a Raleigh-based, tax-exempt system with three acute care hospitals, outpatient centers, and hundreds of physicians across a range of specialties.<\/p>\n<p><strong>Total Bill:<\/strong> $487, which included a $331 wellness visit and a separate $156 charge for what was billed as a 20- to 29-minute consultation with her physician. Her insurer paid $419.93, leaving Rogers with a $67.07 charge related to the consultation.<\/p>\n<figure class=\"wp-block-embed is-type-rich is-provider-documentcloud wp-block-embed-documentcloud\">\n<p>\n<iframe loading=\"lazy\" title=\"Oct 2023 BOTM (Hosted by DocumentCloud)\" src=\"https:\/\/embed.documentcloud.org\/documents\/24041663-oct-2023-botm\/?responsive=1&amp;title=1&amp;embed=1\" width=\"570\" height=\"750\" style=\"border: 1px solid #aaa; width: 100%; height: 800px; height: calc(100vh - 100px); max-width: 570px; max-height: 750px;\" sandbox=\"allow-scripts allow-same-origin allow-popups allow-forms allow-popups-to-escape-sandbox\"><\/iframe>\n<\/p>\n<\/figure>\n<p><strong>What Gives: <\/strong>Rogers said the bill came as a surprise because she knows annual wellness checks are typically covered without patient cost sharing as preventive care under the Affordable Care Act. And as part of an annual physical, patients routinely fill out a health questionnaire, which may cover mental health topics.<\/p>\n<p>But there is a catch: Not all care that may be provided during a wellness visit counts as no-cost preventive care under federal guidelines. If a health issue arises during a checkup that prompts discussion or treatment \u2014 say, an unusual mole or heart palpitations \u2014 that consult can be billed separately, and the patient may owe a copayment or deductible charge for that part of the visit.<\/p>\n<p>In Rogers\u2019 case, a brief chat with her doctor about mental health triggered an additional visit charge \u2014 and a bill she was expected to pay.<\/p>\n<p>Rogers said she didn\u2019t broach the subject of depression during her checkup. She was asked when she checked in to fill out the questionnaire, she said \u2014 and then the doctor brought it up during her exam.<\/p>\n<p>The Affordable Care Act requires insurers to cover <a href=\"https:\/\/www.healthcare.gov\/coverage\/preventive-care-benefits\/\">a variety of preventive services<\/a> without a patient paying out-of-pocket, with the idea that such care might prevent problems or find them early, when they are more treatable and less costly.<\/p>\n<p><a href=\"https:\/\/www.healthcare.gov\/preventive-care-adults\/\">The federal government lists<\/a> dozens of services that are classified as no-cost-sharing preventive care for adults and children, such as cancer screenings, certain vaccinations, and other services recommended by either of two federal agencies or the U.S. Preventive Services Task Force, an independent group of experts in disease prevention.<\/p>\n<p>Depression screening is covered as preventive care for adults, including when they\u2019re pregnant or in the postpartum phase.<\/p>\n<div class=\"wp-block block--newsletter  \" data-type=\"kaiser-health-news\/newsletter\" data-align=\"center\" style=\"\">\n<h4 class=\"newsletter__title\">\n\t\t<a href=\"https:\/\/kffhealthnews.org\/email\/\"><br \/>\n\t\t\tEmail Sign-Up\t\t<\/a><br \/>\n\t<\/h4>\n<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#8217; free Morning Briefing.\t<\/p>\n<\/div>\n<p>Rogers requested an itemized bill from her doctor\u2019s practice, which is part of WakeMed Physician Practices. It showed a charge for the wellness visit (free for her), as well as a separate charge for a 20- to 29-minute office visit. Earlier, Rogers said, she had discussed the initial bill with the office manager at her doctor\u2019s office, who told her the separate charge, roughly $67, was for discussing her questionnaire results with her doctor.<\/p>\n<p>For Rogers, it wasn\u2019t so much about the $67 she owed for the visit, as it was a matter of principle. The separate change, she said, was \u201cdisingenuous\u201d because she was specifically asked about her mental health.<\/p>\n<p>Also, annual physicals are intended to nip health problems in the bud, which sometimes requires a few more minutes of attention \u2014 whether to discuss symptoms of depression or palpate an abdomen for digestive issues.<\/p>\n<p>Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University, agrees the charge seemed a bit over-the-top: Depression screening \u201cis now a recommended part of the annual physical,\u201d she said. \u201cImplicit in that is someone looks at answers and makes an assessment, and you should not be charged for that.\u201d<\/p>\n<p>Beyond the confusion of being charged for what she thought would be free preventive care, Rogers wondered how the bill was calculated: Her conversation with her doctor about depression did not last that long, she said.<\/p>\n<figure class=\"wp-block-image alignwide size-full\"><figcaption><span class=\"photo-credit\">(Kate Medley for KFF Health News)<\/span><\/figcaption><\/figure>\n<p>A 20- to 29-minute-visit billing code is commonly used in primary care, reflecting not just the time spent, but also the complexity of the condition or diagnosis, said Yalda Jabbarpour, a family physician in Washington, D.C. She also directs the Robert Graham Center for Policy Studies, which researches primary care in the U.S.<\/p>\n<p>Billing codes exist for other, shorter time frames, though those are rarely used except for the most minimal of services, such as a quick question about a test result, she said.<\/p>\n<p>Physicians said Rogers did the right thing, emphasizing that patients should be honest with their doctors during preventive visits \u2014 and not keep silent about issues because they are concerned about potential cost sharing.<\/p>\n<p>\u201cIf you have a condition like depression, not only does it affect mental health, but it can have significant impact on your medical health overall,\u201d said Stephen Gillaspy, senior director for health and health care financing at the American Psychological Association.<\/p>\n<p><strong>The Resolution:<\/strong> Confused by getting billed for a visit she thought would have no charge, Rogers initially called her doctor\u2019s office and spoke with the office manager, who told her the claim submitted to her insurer was coded correctly for her visit. She then called her insurer to question whether a mistake had been made. She said her insurer said no, agreeing that the physician had billed properly.<\/p>\n<p>Rogers paid the bill.<\/p>\n<p>After being contacted by KFF Health News, and with Rogers\u2019 permission, the WakeMed health system investigated the bill and said it was handled correctly.<\/p>\n<p>\u201cWe do split bills when a service is provided that is above and beyond the preventive components of a physical \u2014 in this case, beyond a positive screening for depression,\u201d WakeMed spokesperson Kristin Kelly said in an email.<\/p>\n<p>By contrast, Cigna Healthcare, Rogers\u2019 insurer, sent her a new explanation of benefits statement after being contacted by KFF Health News. The EOB showed Cigna had zeroed out any cost to Rogers associated with the visit.<\/p>\n<p>Cigna spokesperson Meaghan MacDonald, in a written statement, said the \u201cwellness visit was initially billed incorrectly with two separate visit codes, and has now been resubmitted correctly so there is no cost-share for Ms. Rogers. We are working with the physician to ensure she is refunded appropriately.\u201d<\/p>\n<p>The <a href=\"https:\/\/static.cigna.com\/assets\/chcp\/pdf\/coveragePolicies\/medical\/ad_a004_administrativepolicy_preventive_care_services.pdf\">insurer\u2019s website<\/a> says Cigna covers a variety of preventive services without copayment and encourages doctors to counsel patients about depression.<\/p>\n<p>Not long after receiving the new EOB, Rogers said she received a refund of $67.07 from WakeMed.<\/p>\n<figure class=\"wp-block-image alignwide size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"3840\" height=\"2560\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg\" alt=\"A photo of a woman posing for a portrait outside.\" class=\"wp-image-1765455\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg 3840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=770,513 770w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=840,560 840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=570,380 570w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=370,247 370w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=270,180 270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=170,113 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=100,67 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=1170,780 1170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=200,134 200w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=315,210 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=630,420 630w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2023\/10\/BOTM_Oct_Rogers_08-resized.jpg?resize=1200,800 1200w\" sizes=\"auto, (max-width: 3840px) 100vw, 3840px\"\/><figcaption><span class=\"photo-credit\">(Kate Medley for KFF Health News)<\/span><\/figcaption><\/figure>\n<p><strong>The Takeaway:<\/strong> While many preventive services are covered under the ACA, the nuances of when a patient pays can be complicated and open to interpretation. So, it is not uncommon for medical practices to narrowly interpret the term \u201cpreventive service.\u201d<\/p>\n<p>That creates a billing minefield for patients. If you respond on a questionnaire that you sometimes experience heartburn or headaches, most physicians will inquire about your responses to assess the need for treatment. But should that come with an extra charge? Other patients have written to KFF Health News and NPR expressing frustration over being billed for conversations during a checkup.<\/p>\n<p>Additional time spent during a wellness exam discussing or diagnosing a condition or prescribing medication can be considered beyond preventive care and result in separate charges. But if you receive a bill for a preventive service that you expected would be free, request an itemized bill with billing codes. If something seems off, ask the physician\u2019s office.<\/p>\n<p>If you\u2019re billed for time spent on extra consultation, question it. You know how long the provider spent discussing your health issue better than a billing representative does. Next, reach out to your insurer to protest.<\/p>\n<p>Most important, be honest with your primary care provider during your annual physical.<\/p>\n<p><em><a href=\"https:\/\/twitter.com\/ReporterSteph\">Stephanie O\u2019Neill<\/a> reported the audio story.<\/em><\/p>\n<p><em>Bill of the Month is a crowdsourced investigation by\u00a0<a href=\"https:\/\/kffhealthnews.org\/news\/tag\/bill-of-the-month\/\">KFF Health News<\/a>\u00a0and\u00a0<a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2018\/02\/16\/585549568\/share-your-medical-bill-with-us\">NPR<\/a>\u00a0that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us?\u00a0<a href=\"https:\/\/kffhealthnews.org\/send-us-your-medical-bills\/\">Tell us about it<\/a>!<\/em><\/p>\n<aside class=\"meta-authors meta\">\n<p>\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"author-name\">Julie Appleby: <\/span><br \/>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/news\/article\/bill-of-the-month-annual-physical-surprise-charge\/mailto:jappleby@kff.org\">jappleby@kff.org<\/a>,\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/twitter.com\/Julie_appleby\" target=\"_blank\" rel=\"noopener\"><br \/>\n\t\t\t\t\t\t\t@Julie_appleby<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n<section class=\"block--category-tag-list \">\n<div class=\"category-tag-list__content-wrapper\">\n<h3 class=\"block--category-tag-list__title\">\n\t\t\t\tRelated Topics\t\t\t<\/h3>\n<p>\t\t\t\t<a class=\"category-tag-list__contact-link\" href=\"https:\/\/kffhealthnews.org\/contact-us\/\"><br \/>\n\t\t\tContact Us\t\t<\/a><br \/>\n\t\t<a class=\"category-tag-list__tip-link\" href=\"https:\/\/kffhealthnews.org\/tips\/\"><br \/>\n\t\t\tSubmit a Story Tip\t\t<\/a>\n\t<\/div>\n<\/section><\/div>\n<p><script async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Christine Rogers of Wake Forest, North Carolina, didn\u2019t hesitate when she was asked to fill out a routine mental health questionnaire during a checkup last November. Her answers on the form led her primary care doctor to ask about depression and her mood, and Rogers said she answered honestly. \u201cIt was a horrible year. I [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1924,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-1923","post","type-post","status-publish","format-standard","has-post-thumbnail","category-mental-health"],"_links":{"self":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/1923","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1923"}],"version-history":[{"count":1,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/1923\/revisions"}],"predecessor-version":[{"id":1925,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/1923\/revisions\/1925"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/media\/1924"}],"wp:attachment":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1923"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1923"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1923"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}