Mary Caravella says that on her Medicare wellness exam on March 4, she had fifteen minutes of face-to-face time with her doctor.
“When we received the bill I was amazed,” Caravella said.
“I didn’t take a physical exam or anything,” he added.
The bill amounted to $ 900. After applying for insurance, he was responsible for $ 129.41, which would be fine in different circumstances, but this appointment was supposed to be fully covered.
According to a spokesman for the Medicare and Medicaid Centers, “If a person with Medicare has had Medicare Part B for more than 12 months, they may receive an annual ‘wellness’ visit to develop or update their personalized plan to prevent illness or “Annual wellness visit is not a physical exam. Medicare covers this visit once every 12 months.”
Caravella’s original bill showed that $ 355 was for the annual wellness visit, which Medicare paid in full. But the second charge for $ 545 was labeled “preventive,” which was not fully covered.
“We’ve been lucky that maybe we can afford it. So it’s not a question of money. It’s a matter of principles and how many people are hurt by it,” said Mary’s husband, Tom.
The couple’s medical provider is Aurora Health Care. We contacted Aurora and a spokesperson provided the following statement:
“While we can’t comment on the details of any patient’s care or billing, our practice is to investigate patients’ complaints and make the necessary efforts to resolve their concerns. Patients who are unsure of how to manage Your insurance claims for office visits should contact your insurance provider.Our commitment to helping people live well includes providing assistance to our patients to navigate the financial costs of their office. Patients can access this useful information on our website and by contacting our Patient Contact Center at 800-326-2250 “.
Days later, we learned that Aurora had resigned as Mary Caravella. Since Caravella has already paid, he will be reimbursed.
Caravella told us that when Aurora called her, a representative also informed her that they would be training staff on how to properly manage Medicare wellness exams because if a patient comes in and the services extend beyond what is covered, they will let you know that it could be charged.
Vicki Buchholz is on the Wisconsin Board of Aging and Long-Term Care.
“There needs to be this communication to understand when that visit changed,” Buchholz said.
“If the provider performs additional testing or services during the same office visit, that part of the office visit becomes a paid service that may result in the beneficiary having to cover the deductible or 20%. Another reason a person may be charged with these visits is if their doctor does not accept Medicare “assignment” for their services, which means that the provider can charge up to 15% on the amounts. approved by Medicare, “he said.
Caravella says he did not talk about any health issues during his visit. She says she just agreed to refill her recipe.
Buchholz says that despite what may be considered a surprise bill, this should not deter seniors from talking.
“If they come in for a wellness visit but they really have a pain, they need to talk about it,” he said.
“Beneficiaries are advised to ask their doctor at the beginning of the appointment what their visit includes, so that they can then decide if they want to request another appointment for other services or if they want to save the trip for that other visit and combine both, which means they will be charged out of pocket after Medicare, “he said.
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