Author Topic: HDHP Question: Are office visit fees common?  (Read 735 times)

Schaefer Light

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HDHP Question: Are office visit fees common?
« on: September 21, 2019, 06:36:55 PM »
I was having a nice day until I received a bill for $540 for a recent physical.  There were some tests that weren't fully covered by my high deductible insurance plan, but what's really got me upset are the charges for the two office visits - one for lab work and one for the exam.  On the initial visit, there was a $220 charge for "OFFICE/OUTPATIENT VISIT NEW" (of which my insurance covered $70).  On the second visit, there was a $150 charge for "OFFICE/OUTPATIENT VISIT EST" (of which my insurance covered $0).  So, $300 of my $540 bill is for visit fees. 

Has anyone else with a HDHP run into this?  If so, have you had any luck getting these fees reduced or eliminated?  I had no idea I was going to pay $150 every time I walked in the door.  I'm planning to call the doctor's office on Monday to see if there's anything they can do.

I must say I'm not a huge fan of HDHPs at this point.  I have to see a couple of specialists multiple times per year, and even though having access to an HSA is nice I was much better off financially with a traditional co-pay plan.  Unfortunately, my employer doesn't offer a traditional plan.

MayDay

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Re: HDHP Question: Are office visit fees common?
« Reply #1 on: September 21, 2019, 07:18:15 PM »
Yes this is typical.

Yes you will pay for every office visit, and 150$ sounds about right.

It's painful to pay the bill but if you do the math on the reduced premiums you almost always come out ahead. You just need to either mentally or physically (ie move to a health savings account) budget for the bills with the money you are saving on premiums.

Schaefer Light

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Re: HDHP Question: Are office visit fees common?
« Reply #2 on: September 21, 2019, 07:29:21 PM »
Yes this is typical.

Yes you will pay for every office visit, and 150$ sounds about right.

It's painful to pay the bill but if you do the math on the reduced premiums you almost always come out ahead. You just need to either mentally or physically (ie move to a health savings account) budget for the bills with the money you are saving on premiums.
So, do you have to pay $300 to get a physical?  It seems like this would really discourage people from getting annual physicals.

use2betrix

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Re: HDHP Question: Are office visit fees common?
« Reply #3 on: September 21, 2019, 08:07:29 PM »
I have a HDHP plan. I see the doctor for a prescription refill every other month, itís around $70 if i pay cash, and around $100 if I pay through insurance (but the insurance goes through my deductible, while if I pay cash, it does not, either could be reimburse by my HSA, though.)

I always thought that all insurance plan had to cover preventative care, maybe an annual physical, too?

Schaefer Light

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Re: HDHP Question: Are office visit fees common?
« Reply #4 on: September 22, 2019, 06:12:12 AM »
I always thought that all insurance plan had to cover preventative care, maybe an annual physical, too?
You're correct, but I guess the question is "what counts as preventative care?"  I would have thought that an office visit related to a physical would be covered.  Guess I was wrong.  Most of the lab work (blood tests) weren't covered, either. 

I think HDHPs need to cover the stuff that's typically done during a physical or people with HDHPs are going to stop having physicals...which doesn't seem like the type of thing that will be good for minimizing medical costs in the long run.

SKL-HOU

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Re: HDHP Question: Are office visit fees common?
« Reply #5 on: September 22, 2019, 08:33:29 AM »
Annual physical/checkup should be covered at no cost under high deductible plan, any plan. If they have done something above the typical checkup for someone your age then those wouldnt be covered.

MayDay

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Re: HDHP Question: Are office visit fees common?
« Reply #6 on: September 22, 2019, 09:00:27 AM »
If they do things during the physical that are not part of the physical, they will bill accordingly and you will pay.

Yes, the plain physical should be free. It could be an error- doesn't hurt to call and ask. They could have picked the wrong code I the computer system or something.

less4success

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Re: HDHP Question: Are office visit fees common?
« Reply #7 on: September 22, 2019, 09:13:49 AM »
Unfortunately, this is par for the course, and a good example of why HDHPs are frustrating (even if you end up saving money).

I think the key is physical vs. office visit. I went in for what I thought was a physical and because I asked the doctor a question, that allegedly changed the nature of the appointment to an office visit (which is not free).

I paid the bill, but was annoyed.
« Last Edit: September 22, 2019, 11:01:35 AM by less4success »

use2betrix

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Re: HDHP Question: Are office visit fees common?
« Reply #8 on: September 22, 2019, 10:36:16 AM »
I get skin cancer screenings every year or two, due to having skin cancer in my late 20ís. You would ďthinkĒ this would be preventative care, however I still ended up needing to pay out of pocket. It was around $100 or so.

I believe that annual physicals should be covered, but at what point do you draw the line of what is included in an annual physical? To me, I just think of ďroutineĒ as being a short physical exam with a physician. Does that include blood work, whatís next? Annual MRIís/Cat scans for cancer screenings? Etc? The line has to be drawn somewhere.

FYI - for bloodwork, you can save a LOT of time and money (if youíre paying out of pocket) by going to www.privatemdlabs.com and ordering the bloodwork package you want. You simply pay online, print out your requisition, take it to a local lab, they take blood, and email you the results. In this day and age, unless you have health issues, a normal person can interpret the results easily (it tells you whatever is out of range) and google can do quite a bit of the rest.

That saves you from having to meet with the doctor (time, cost of visit) have them set up the bloodwork (separate appt (time) cost of bloodwork) then another appt back with your doctor (time, cost of visit) for him to tell you youíre fine, or tell you things you could have googled with even more information online.

I get bloodwork from there around twice a year just depending on a few things. It usually costs around $120-$180 depending what all tests I want done. Iíve probably had bloodwork from Privatemdlabs done 15-20 times over the last 6-7 years.


Unfortunately, this is par for the course, and a good example of why HDHPs are frustrating (even if you end up saving money).

I think the key is physical vs. office visit. I went in for what I thought was a physical and because I asked the doctor a question, that allegedly changed the nature of the appointment to an office visit (which is not free).

I paid the bill and promptly found a new doctor.

I donít think this is necessarily the doctors fault to be honest. I think itís insurance and the ways they are required to bill. They are not able to write a prescription for what would be an office visit, during a routine physical.

Now that you bring this up, I went though the exactly same thing last year. I had to get an annual physical and they made me set up a separate appointment to get my prescription refill. It was a huge pain in the ass, but I donít blame the doctor. The physical was free.

bacchi

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Re: HDHP Question: Are office visit fees common?
« Reply #9 on: September 22, 2019, 10:38:18 AM »
Unfortunately, this is par for the course, and a good example of why HDHPs are frustrating (even if you end up saving money).

I think the key is physical vs. office visit. I went in for what I thought was a physical and because I asked the doctor a question, that allegedly changed the nature of the appointment to an office visit (which is not free).

I paid the bill and promptly found a new doctor.

Yep. I'm careful not to ask any questions. It somewhat makes an annual less effective:

doc: "Anything going on?"
me: "Nope."

It's just cheaper, but less efficient, to come back for an office visit rather than have the entire annual billed to me.

Another example of why US health care sucks.

Cranky

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Re: HDHP Question: Are office visit fees common?
« Reply #10 on: September 22, 2019, 10:51:54 AM »
Is there a demonstrated health benefit to having Annual Physicals, for an otherwise healthy adult?

I go to the doctor when I'm sick. Every so often bloodwork gets done. Outside of standard "well woman care" (paps/mammograms) I'm not sure I see the point of going to the doctor to have them look for something wrong.

bacchi

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Re: HDHP Question: Are office visit fees common?
« Reply #11 on: September 22, 2019, 10:56:13 AM »
Is there a demonstrated health benefit to having Annual Physicals, for an otherwise healthy adult?

Good question. I know there are studies about the 6 month dental checkup -- it's not needed for people with healthy teeth/gums.

gatortator

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Re: HDHP Question: Are office visit fees common?
« Reply #12 on: September 22, 2019, 11:09:12 AM »
interested in this topic as annual enrollment is coming up...

I found this IRS notice that expands some of the preventative care covered under the HDHP.

https://www.irs.gov/newsroom/irs-expands-list-of-preventive-care-for-hsa-participants-to-include-certain-care-for-chronic-conditions

and also this quote within
Quote
Notice 2004-23 clarifies that preventive care generally does not include any service or benefit intended to treat an existing illness, injury, or condition.

I really need to sit down and read through this to fully understand what is/is not covered.  and probably make a table or two of my own before November.
« Last Edit: September 22, 2019, 11:11:12 AM by gatortator »

less4success

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Re: HDHP Question: Are office visit fees common?
« Reply #13 on: September 22, 2019, 11:24:16 AM »
I paid the bill and promptly found a new doctor.

I donít think this is necessarily the doctors fault to be honest.

Really, it's my fault for not knowing that a physical could turn into an office visit based on a 30 second conversation. Anyway, I edited my post to remove that detail since it's not really relevant to this thread.

Finances_With_Purpose

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Re: HDHP Question: Are office visit fees common?
« Reply #14 on: September 22, 2019, 12:07:39 PM »
Annual physical/checkup should be covered at no cost under high deductible plan, any plan. If they have done something above the typical checkup for someone your age then those wouldnt be covered.

Yes, preventative-only visits were covered under mine, however, the office aide can easily screw up the billing and you end up paying.  Plus, you pay for anything other than a routine physical.  I've had it happen where I come in for a routine physical, get one, ask another question with a 30-second answer, and suddenly get billed for the whole thing as though I never had a preventative visit because the office clerk added a note on the billing. 

I spent a good bit of time calling and trying to fix it, to no avail. 

Medical billing/insurance is a scummy business.  In practice, the "free physical" is a sales gimmick. 

So, in practice, I didn't depend on getting ANY free visits with an HDHP and that's often how it worked out.  You ask anything else, and you're going to get billed for the whole shebang, or you have to set up another whole appointment to ask a single question. 

Most people who choose an HDHP still come out ahead even with the cost of the physical, so I would just assume you're on the hook for it and ask whatever you want then, or just go ahead and do it with another visit you're doing, etc.

Psychstache

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Re: HDHP Question: Are office visit fees common?
« Reply #15 on: September 22, 2019, 01:14:15 PM »
I'm on a HDHP and don't get annual physicals, but I donate blood 3-4 times a year (because I like to) and you basically get a mini physical as part of the process. I have a spreadsheet with all of my key numbers going back years, so I figure if I ever see some kind significant change in the numbers I'll look into it.

seattlecyclone

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Re: HDHP Question: Are office visit fees common?
« Reply #16 on: September 22, 2019, 02:11:51 PM »
Yep, the second you ask a question about some health concerns you have, you're not there purely for preventive purposes anymore and you're billed accordingly. Seems like a pretty silly distinction to make ("preventive" or not), but that's the system we have. I can say that I have gotten a physical with associated blood work (to check cholesterol levels and other things) with HDHP coverage and paid nothing because I didn't open my mouth about anything that the doctor didn't bring up first.

Is there a demonstrated health benefit to having Annual Physicals, for an otherwise healthy adult?

I read this really interesting book a few years ago where the author visits a bunch of different countries to compare their medical systems. One thing they mentioned was that the UK in particular does not cover periodic "well visits" to physicians because they do not believe they provide sufficient benefit to be worth the cost. I tend to agree. Seems rather unlikely that a doctor poking and prodding you for a bit will uncover some condition you didn't already have some good idea you had.

NotJen

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Re: HDHP Question: Are office visit fees common?
« Reply #17 on: September 22, 2019, 02:34:24 PM »
Is there a demonstrated health benefit to having Annual Physicals, for an otherwise healthy adult?

I go to the doctor when I'm sick. Every so often bloodwork gets done. Outside of standard "well woman care" (paps/mammograms) I'm not sure I see the point of going to the doctor to have them look for something wrong.

I didnít realize that an annual physical was a ďthingĒ, so Iíve never had one as an adult.  Is this something most people do?

Schaefer Light

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Re: HDHP Question: Are office visit fees common?
« Reply #18 on: September 22, 2019, 02:53:19 PM »
Seems rather unlikely that a doctor poking and prodding you for a bit will uncover some condition you didn't already have some good idea you had.
You'll certainly know if you're experiencing any pain before seeing the doctor, but there are many conditions that are uncovered based on the blood work that commonly takes place as part of the physical.  Consider a blood disorder like hemochromatosis, for example.  It could progress to a point where you have liver damage before you even know something is wrong.

I don't know what percentage of the population gets a physical each year, but many employers' health plans strongly incentivize employees to get one.  As in, your premium payments will be cut in half if you get one.

use2betrix

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Re: HDHP Question: Are office visit fees common?
« Reply #19 on: September 22, 2019, 03:05:17 PM »
Is there a demonstrated health benefit to having Annual Physicals, for an otherwise healthy adult?

I go to the doctor when I'm sick. Every so often bloodwork gets done. Outside of standard "well woman care" (paps/mammograms) I'm not sure I see the point of going to the doctor to have them look for something wrong.

I didnít realize that an annual physical was a ďthingĒ, so Iíve never had one as an adult.  Is this something most people do?

I only did  the annual physical last year (basically a joke) as it was required to have recuced insurance costs for the following year.

It didnít add any value in my opinion.
« Last Edit: September 22, 2019, 07:34:16 PM by use2betrix »

McStache

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Re: HDHP Question: Are office visit fees common?
« Reply #20 on: September 22, 2019, 03:18:48 PM »
My physicals have always been covered under insurance with HDHPs no matter what questions I asked (maybe this varies a bit from office to office).  Some labs have, some haven't.

You can always file a grievance with your insurance as well as trying the dr office angle as it does seem (logically, though health insurance in the US is far from logical...) that at least most of the visit should have been covered under preventative medicine.  It seems a bit like throwing a note into a black hole, but filing grievances has worked for me in the past and gotten things that were initially not covered as preventable covered.

seattlecyclone

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Re: HDHP Question: Are office visit fees common?
« Reply #21 on: September 22, 2019, 04:23:06 PM »
Seems rather unlikely that a doctor poking and prodding you for a bit will uncover some condition you didn't already have some good idea you had.
You'll certainly know if you're experiencing any pain before seeing the doctor, but there are many conditions that are uncovered based on the blood work that commonly takes place as part of the physical.  Consider a blood disorder like hemochromatosis, for example.  It could progress to a point where you have liver damage before you even know something is wrong.

I don't know what percentage of the population gets a physical each year, but many employers' health plans strongly incentivize employees to get one.  As in, your premium payments will be cut in half if you get one.

Sure, there certainly exist conditions that would be diagnosed from running periodic lab tests on healthy-seeming people. The UK's NHS does not believe these tests provide results frequently enough to stand up to a cost/benefit analysis and so they don't cover them. Are they wrong?

For a few years my former employer gave every employee who went in for a physical an extra $200 toward their HSA. They eventually quit doing that and just gave the $200 to everybody.

Old policy costs: ($200 + cost of physical - cost savings from any diseases caught early by the physical) * (number of employees taking a physical)
New policy costs: ($200) * (number of employees)

That company has been pretty cost-conscious lately. They haven't been making many decisions out of a pure desire to increase employee happiness. My assumption is that they ran the numbers and determined that the cost savings from catching diseases early from physicals and from not paying the $200 to employees who skipped their physicals was less than the cost of buying all those exams for employees who were only doing it to get their $200.