My friend said she got a free annual physical with Medicare, but my doctor billed me. What's going on?
Answered by 21 licensed agents
Medicare does not provide annual physicals; these are called wellness exams. If the doctor bills it as a physical, you will most likely pay 100%. However, if you have a Medicare Advantage plan, it may be covered as an annual physical under your policy coverage. All Medicare Advantage plans are different, and their coverage for these items varies; check your policy.
Under traditional Medicare Part A and B, you can receive a yearly wellness exam. Talk to your doctor about the upcoming exam and what it entails.
Annual physicals are always free with Medicare. Perhaps your doctor is not in network? Your agent should always check and ascertain that your primary care physician is in network.
Tip: Always ask your doctor’s office about what exactly is covered during your visit to avoid surprise bills! If your doctor billed you, it might be because they did a more detailed physical exam, which isn't fully covered under the Medicare wellness visit.
Find out the difference in the coverages between you and your friend and you will have your answer. Doctors actually could not care any less about Medicare costs. So, since true physicals are covered, it comes down to how the visit was “coded” by the doctor's billing department. If they mis-code the visit, they are no longer permitted to fix their error.
The reason for getting a bill may not be a result of Medicare but rather the difference between an annual wellness visit which is covered by Medicare versus a routine physical which is not. Sounds confusing, I know, but the services are different. An annual wellness visit is designed to prevent disease and/or disability via a health risk assessment whereas a routine physical is catergorized as a general check up.
The first thing that comes to mind is that your Doctor isn't in the network of your Plan. This is a common mistake that people make when letting a caller sign them into a Plan or when they go on-line and enroll themselves. MEDICARE is confusing...and people should always trust an Independent Broker to help them...and remember...a Broker never charges the client a fee for their help.
Medicare does not have free annual physical exams but DOES have a yearly wellness visit. It's possible that your friend has a Medicare Advantage Plan and most of those have a $0 copay for visits to your primary care physician.
If a doctor builds you always question it. Check your explanation of benefits before you pay any bill. Often doctors will bill you because they haven't been paid yet and it's lagging or something like that by the insurance company or Medicare. And also depends on whether you have a Medicare advantage plan or a Medicare supplement plan. If it's a supplement plan, Medicare pays first and then your plan pay-c remaining 20%. You do have an annual deductible for doctor visits of $257 this year. Once that's been met you would not have any further charges for the rest of the year. If you'd like to go over this in more detail, give me a call at 737-530-4626 pick option 2. That's my direct line. If it's busy, just leave a message and I'll call you back
There is a lot of confusion about what Medicare will and will not cover under the " free " status so far as it pertains to an annual physical.
What Medicare will pay for isa a visit that only addresses health maintenance and preventive care. Included in the Medicare annual wellness visit there is no requirement for an actual hands-on physical exam such as listening to your heart and lungs.
It is really just to check on stuff that is not actively going on that you might not have symptoms of—and that’s what makes it different from other types of visits where you usually go in because either you’re sick, you’re not feeling well, there’s something wrong or you already have a disease that you’re managing and want to make sure that it hasn’t gotten worse or ... what to do next for it. Medicare calls the visit to the doctor an Annual Wellness visit. There is also a one time Welcome to Medicare visit which is covered by Medicare at 100% but it is not the same as a comprehensive Physical Exam.
You must tell the doctor when you make the appointment for the annual physical that this appointment should be submitted as your Free annual physical. You see doctors don't get paid the same as if it was a regular visit.
If your doctor billed you, he/she probably does not take Original Medicare; or he/she takes Medicare, but is out of your plan's network; or his/her rate is above (up to 15%) of Medicare allowed rate.
I would check with your Dr and contact member services with your plan. There could be a coding issue on the Dr's end or something on the carrier's end.
Original Medicare only provides a "Welcome to Medicare" physical the first year. After that you will have to pay if you stay on Original Medicare. If you have a Medicare Advantage or Medicare Supplement the Annual physical is at a $0 cost.
Medicare does not provide an annual physical but rather a wellness exam. If the doctor billed it as a physical then you will pay 100%. If you have a Medicare advantage plan the plan MAY cover an annual physical.
The doctor may of billed for something outside of the annual physical that came up in their consultation. One example could be a requested test or lab by the doctor.
There could be many reasons that one person is billed for a service and another is not. Medicare covers something called an Annual Wellness exam. This is not the same thing as a traditional annual physical. It normally consists of the provider asking a series of questions, but it does not include a hands-on physical or lab work. If your provider did a hands-on physical and ordered labs, that may be why you saw a charge and your friend did not. Another reason may be that your provider billed you, and your friends did not. It is up to the provider to correctly bill Medicare or insurance for services performed.
Your annual physical is a preventive service so there should be no cost But it depends on the coding that the doctor's office used. If you discussed anything with the Dr to prompt further diagnostics they will code it as a diagnostic exam instead of preventive. If you think it was a mistake I would call the billing office for the Dr.
You may have had additional tests or an exam that was different from the Medicare wellness exam. Please call your clinic billing department to ask for a detailed explanation.
