The "free preventive health exam" that was constructed by the government and the insurance industry has very specific rules regarding what constitutes the
Preventive ExamThese rules are set by the insurance company, not by the physicianDuring the "free" preventive health visit, only preventive health issues are discussed (Paps, mammograms, colonoscopies, screening labs, etc.), not any acute or chronic medical issuesIf other issues are discussed, the visit is no longer a preventive health visit, it becomes a "problem oriented" visit per the insurance rulesProblem oriented visits are subject to a copay, deductible and or co-insurance per the patient's insurance plan
When a patient has a problem, whether acute or chronic, they can be discussed during the preventive health visitAt this point, the visit ceases to be a free preventive health visit and becomes a problem oriented visitAlternately, the patient can be seen twice, once for their acute or chronic issues, and a second time for their preventive health visitIn this scenario, one appointment is free to the patient, and the other is a visit subject to the patients copaySome patients opt for the two visit approach and some patients prefer the efficiency of getting things done in a single visit
With regards to the billing issues, if the patient is seen twice, the insurance gets billed twice, and I get paid the FULL amount for the services twiceIf the visits are combined, the insurance company allows the physician to bill for the two separate services, both the preventive health and problem issuesHowever, in this case, I get paid in fully for one service and get paid a DISCOUNTED rate for the second serviceThis is the industry standardFrom a purely business standpoint, it is better for me to see the patient twiceBy seeing the patient once, I save the insurance company money and I save the patient the inconvenience of having to have a second appointment
In this particular case, the patient complained of an acute problem during her preventive health visitThe problem was properly documented in her chart, and a prescription was written for that problemIn addition, she had her preventive health visitBoth issues were properly documented in the chart and both issues were billed to her insurance per the insurance rulesBoth issues were properly paid by her insurance company (one in full, one discounted)I assure you, if the insurance company thought there was any "double billing" going on, they would have denied the claimThe previous year, the patient had no complaints and her exam was purely a preventive health exam and therefore free to her
*** *** *** *** *** for most group plans, require that the deductible be met prior covering any labs, x-rays, procedures, and some injectionsAlthough, we do show that statements went out to your current address along with the collection letter, I do agree that the mail will get
lost.
Please accept my apology for any inconvenience this has caused youPer Dr***,'s request, Iv'e contacted ***, collection agency, to rescind the chargesDr*** has completely written this off
The "free preventive health exam" that was constructed by the government and the insurance industry has very specific rules regarding what constitutes the
Preventive ExamThese rules are set by the insurance company, not by the physicianDuring the "free" preventive health visit, only preventive health issues are discussed (Paps, mammograms, colonoscopies, screening labs, etc.), not any acute or chronic medical issuesIf other issues are discussed, the visit is no longer a preventive health visit, it becomes a "problem oriented" visit per the insurance rulesProblem oriented visits are subject to a copay, deductible and or co-insurance per the patient's insurance plan
When a patient has a problem, whether acute or chronic, they can be discussed during the preventive health visitAt this point, the visit ceases to be a free preventive health visit and becomes a problem oriented visitAlternately, the patient can be seen twice, once for their acute or chronic issues, and a second time for their preventive health visitIn this scenario, one appointment is free to the patient, and the other is a visit subject to the patients copaySome patients opt for the two visit approach and some patients prefer the efficiency of getting things done in a single visit
With regards to the billing issues, if the patient is seen twice, the insurance gets billed twice, and I get paid the FULL amount for the services twiceIf the visits are combined, the insurance company allows the physician to bill for the two separate services, both the preventive health and problem issuesHowever, in this case, I get paid in fully for one service and get paid a DISCOUNTED rate for the second serviceThis is the industry standardFrom a purely business standpoint, it is better for me to see the patient twiceBy seeing the patient once, I save the insurance company money and I save the patient the inconvenience of having to have a second appointment
In this particular case, the patient complained of an acute problem during her preventive health visitThe problem was properly documented in her chart, and a prescription was written for that problemIn addition, she had her preventive health visitBoth issues were properly documented in the chart and both issues were billed to her insurance per the insurance rulesBoth issues were properly paid by her insurance company (one in full, one discounted)I assure you, if the insurance company thought there was any "double billing" going on, they would have denied the claimThe previous year, the patient had no complaints and her exam was purely a preventive health exam and therefore free to her
*** *** *** *** *** for most group plans, require that the deductible be met prior covering any labs, x-rays, procedures, and some injectionsAlthough, we do show that statements went out to your current address along with the collection letter, I do agree that the mail will get
lost.
Please accept my apology for any inconvenience this has caused youPer Dr***,'s request, Iv'e contacted ***, collection agency, to rescind the chargesDr*** has completely written this off