To Be Governed
A long list of services do qualify as preventive care under the Affordable Care Act, including vaccinations and screenings for diabetes, depression, high blood pressure, high cholesterol and several cancers. Most insurers will cover one such preventive visit per year with no charge to the patient.
But care related to existing health problems, or new issues, is considered “evaluation and monitoring,” not preventive…
Some offices now ask patients to schedule separate annual visits — one for preventive care (with no out-of-pocket cost) and one to discuss problems (with the usual deductible and copay). Medicare also encourages preventive care with its annual free “wellness” visits. But when elderly patients learn they can’t bring up ongoing health issues at such a visit without being charged, many don’t bother, doctors say. (WSJ)
Some offices now ask patients to schedule separate annual visits — one for preventive care (with no out-of-pocket cost) and one to discuss problems (with the usual deductible and copay).
Sounds convenient.
“Oh, you’ve cut off your arm? Gosh, sorry – this is your preventive care visit. We can discuss that next time!”
It is hard enough getting me to go see a doctor, now if I have to make multiple visits, the cost definitely outweighs any benefit.
This is what happens in Canada. Living in British Columbia, my doctor told me that if I mentioned two or three complaints to him in one visit, he would have to schedule one or two more visits to deal with those issues. If not, he could not bill BCMSP (British Columbia Medical Services Plan).
This kind of interference will always persist in 3rd-party payer systems, because that payer cannot efficiently observe what is going on in the physicians’ offices.
Another perverse incentive, and a no-win for doctor or patient. Even if the doc wanted to be address the complaint on a preventive visit, he or she would have to document it, and then it would not be paid for as a preventive visit.
A family member recently had a colonoscopy, which is a “no cost” preventive procedure. A cancerous polyp was removed, which now makes it a “treatment” so he will get the full bill since he has a high deductible.
By the same token, thank goodness the cancer was detected.
Several years ago I read about how people with HSAs (which included some preventative care) needed to be very careful when scheduling a physical to only get a physical. Asking about another condition could easily get the office visit reclassified (i.e. billed) as something other than preventative and would not be covered by the insurers. Rather, it would come out of the patients’ HSA. Some of these issue may still exist under the ACA.
“That is hard for some patients to grasp, doctors report. “They’ll say, ‘I have diabetes and hypertension and heart disease and seeing you is preventing them from getting worse, so that should be fully covered,’ ” Dr. Wexler says. “But under that theory, everything would be free with no copay.””
A lot of people actually thought care was going to be free under the ACA.
Surpriiiiise!!
Vaccinations are preventive, and effective. But are they considered preventive care? If they are, that should mean parents getting the hundreds of dollars worth of recommended vaccinations for their kids should always get them free. But is that the case?
“evaluation and monitoring,”
Ah yes, new terminology in order to get around the new law. It’s already happening.
This is ridiculous. If you go in for a physical, you can’t mention if something else is bothering you or not. You have to schedule another visit. Absolutely ridiculous.
This all reeks of the health care system being sneaky and dishonest.
That’s what you get when it is run by bureaucrats.
“Medicare also encourages preventive care with its annual free “wellness” visits. But when elderly patients learn they can’t bring up ongoing health issues at such a visit without being charged, many don’t bother, doctors say”
The U.S. health care system is all screwed up. I wouldn’t want to receive any healthcare in the U.S. even if I could
As long as your health care isn’t being paid for by government in the US, you’re fine.