Wednesday, February 26, 2014

Obamacare Casualty: Conversations with your Doctor could COST YOU

Patient alert: If you’re going to your doctor for an annual preventive exam and expect it to be covered 100 percent by your insurance company, think again. 
You could be charged for an extra “office visit” if you ask questions about existing medical problems, such as high blood pressure or cholesterol. 
It happened to me in 2012 when I saw my family doctor for an every-other-year checkup. My insurance paid $256, the total for the preventive exam. But the “explanation of benefits” showed that I also owed $74.60, my share of the $113 bill for an “office visit” – on the same day, in the same time slot. 
Puzzled, I called my doctor, Dr. Dael Waxman at Elizabeth Family Medicine. He explained the second charge resulted from our talk about my elevated cholesterol level, which had been diagnosed previously. Because he documented that discussion and marked the billing code for evaluation and management of a cholesterol diagnosis, I was billed for the second visit.
There are multiple factors at work here. This practice of billing for an extra visit began before the Affordable Care Act’s insurance mandate took effect Jan. 1. But some doctors and insurance companies may be using this opportunity to more strictly follow guidelines about what qualifies as a preventive service under the act, and must be covered 100 percent without patient cost-sharing.
In addition, doctors are under pressure to document everything appropriately in the electronic medical record or they could be subject to Medicare reimbursement cuts in the future. That takes more time, so they have less time to handle extra questions from patients. And with the growing prevalence of high-deductible insurance policies, patients may save their questions for the preventive exam, hoping they can avoid paying the full cost of a separate medical visit. 
“It’s a Catch-22,” Kanelos said. “I want to be able to say, ‘What’s going on? Is there anything wrong with you?’… In the old days, that’s the way I picked up a lot of problems. ... Now, it is hard to figure out what to do.”
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