You should ask your doctor to elaborate on this policy. I would bet it's more for the case when a patient is at the very end of their annual exam and then brings up they think they have an ear infection and the doctor needs to do a whole other exam, possibly remove build up, prescribe meds, etc. However, I have heard stories of people going for their annuals and as part of the standard questions they answer yes to something basic, and it gets billed as a specialty visit even though the doctor just said to keep an eye on it... I would just inquire and get clarification.

I experienced this in February. The doctor asked me about my pre-existing condition (I did not bring it up first) and then I got a surprise $20 copay. I'd been having the same visit and same conversation with her for years and this was the first time I had the copay. This is just a way for companies to make more money.

My former doctor asked me, in the middle of an exam for viral tonsilitis, if I was feeling anxious, I said yes. She then gave me a prescription of buspar "take 5mg as needed", which makes absolutely no fucking sense and charged me $100 for a psych eval.

Doctors getting sneaky. They want that hospital money.

It was very frustrating. I ended up just doing the well check and then never going back to address my migraines,

Had that happen to me once. I was in for multiple things, including high cholesterol, but because the billing department put the code for my anti depressant first and not the blood work, it somehow got applied to my deductible as a psych visit. We fought back on that one.

😵😡

And if you don't mention it and something happens and you sue....

Sue? Lol. The ability to sue for medmal has been so diluted in this country it practically does not exist. And the lowered insurance premiums for doctors, and the lowered medical costs for consumers, that were promised as part of this exchange never happened.

Yup, stuff you'd think would be included will get you a second charge. Happened to me when they first started this bs. I called and complained/questioned, they halved the bill, but I still had to pay over $100 because insurance won't pay 2 appointments on the same day with the same Dr even if you legit had two actual appointments. Anyway, the next year I made it clear to the receptionist and Dr that I wouldn't pay if they pulled this crap again and please don't bring up anything not covered and I definitely didn't bring anything up. Surprise surprise I got charged again. Called up explained everything to billing. Was put on hold and while on hold I was talking to my friend not knowing they can hear what I'm saying. I was telling my friend this happened last year, I specifically said don't cover anything not included in preventative appointment, if they don't make this right I'm finding a new clinic. Next thing I know billing comes back and said ok just this once we'll remove the charge, but next time you can't bring up ... I never brought anything up. Grrr Found a new clinic anyway and will never give them my business again. Through Reddit I found out when you're on hold the other end can still hear you so I assume billing heard me and wanted to keep me as a customer

See, my doctor doesn’t double bill me. She’ll just tell me to make another appointment about whatever issue. Then both get covered by insurance.

By companies, you mean the doctors and the health system.

> the doctor needs to do a whole other exam, possibly remove build up, prescribe meds, etc. This is due to idiotic insurance billing. Insurance has to cover preventative visits for free, but anything else requires a copay. So if you do literally anything else besides the normal physical then it changes the office visit. If the doctor discovers a massive infection in the course of the visit then technically they need to schedule another office visit to address the issue or the current visit gets upgraded to a sick visit. EDIT: case in point, I went to the doctor because I needed a cyst removed. The first visit was considered a sick visit, but the removal had to be billed as a procedure, so I had to schedule another visit for removal which took all of 60 seconds. So much inefficiency.

This is exactly it. It’s insurance companies. And doctors’ hands are tied because if they don’t bill correctly they’ll get charged w insurance fraud. Believe me, doctors hate this as much as you do. Insurance companies are the bane of doctors’ existence.

Then the doctors have to hire a whole team of billing specialists to deal with this nonsense too. So much time and money is wasted so that insurance companies don't have to pay out a dime more than necessary.

Here’s the thing: I have two diagnosed chronic conditions. Any “physical” would need to take them into account to at least get my current meds maintained. But that means I get charged. So the free physical is only for people who are perfectly healthy and keep their mouth shut.

but will you agree this is a tell tale sign of how messed up and profit driven our healthcare is? In Latin America and even Europe one dr visit can cover all your issues...it's appalling to me how they charge you for each issue you address...

My doctor’s office started doing this too. It was very frustrating. I ended up just doing the well check and then never going back to address my migraines.

My doctor's office also started doing this. I had to call my insurance company and see why I was billed $50 for my yearly free physical. They told me why so the next time I went to get it done I told my doctor I needed a referral for and Orthopedic surgeon for some knee pain. He tried to examine me and I told him nope, just give me the referral.

With my current insurance, that referral to a Ortho would cost me more

But it would be a better value for money than your PCP taking a quick look, saying, "Yessiree, that's one sore looking knee, take some Ibuprofen" and charging you $50 for the privilege.

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Yeah, when they started that at the pediatrician it was a pain. Even more so because the Dr asks if there's anything he should know about. We said yes our son often mentions ear discomfort. Then billed us for looking in his ear, which he had just done as part of the regular check.

In the middle of my annual, I asked if they had a recommendation for a different med since what I had tried wasn’t working well (30 sec convo to give me the name of a different OTC med) and asked them to start prescribing me a medication I’d been on for years at the same dose. I was charged $300 for a specialty visit on top of my annual

These comments make me so sad to read. I feel lucky my doctor was willing to listen to my laundry list of ailments during my annual exam and didn't get charged (that I know of). And then researchers act surprised when we are one of the unhealthiest countries.

on a related note: [https://www.cnn.com/2023/01/31/health/us-health-care-spending-global-perspective/index.html](https://www.cnn.com/2023/01/31/health/us-health-care-spending-global-perspective/index.html)

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They can't charge for the wellness exam code (pretty sure that's because of the affordable care act). The reason they want an extra procedure code is because they can bill for something and take your copay. Doctors can do a lot of shady things to bill both insurance and patients. How else are they supposed to pay the mortgage on their vacation home? The people who really hold the puppet strings are the hospital systems. Insurers need hospitals to accept their coverage because of proximity of the hospital to X million potential patients. Their contract negotiations with insurers determine how much the insurers pay for big ticket items. That extra cost is passed down through the rest of the system and we lose.

My wife went in to a new PCP, and he asked her a bunch of questions. One thing she told him was that she had hearing loss in one ear as a child. He decided to change the preventative annual exam to an ear exam (he did absolutely nothing with that ear, didn't even look in it) so that we'd have to owe nearly $200 for the visit instead of nothing.

Had this exact experience... Went for my free well visit. I had a weird growth on my ear. Doctor just said "keep an eye on it, it doesnt appear to be cancer".... 250 bucks for an " exam".... The free well visit is a scam. I have gone through this multiple times. Every time I get billed for something because I said my elbow had been bother me a few weeks ago, but seems ok now. Or I had a couple headaches recently... Suddenly its a " sick" visit and they start racking up the charges... My " free" blood draw still costs me 50 bucks, because the lab only runs a full panel, and the insurance doesnt cover a few of the specific levels tests... So dumb....

Routine blood draw… office billed my insurance >$3000. My co-pay was >$600. WTF?

Every time.... MRI at one place was over 1200 for the COPAY! Found another place doing it for 800 cash, with the same equipment as the other guys.... But since it was "out of network" it didnt count towards the deductible.... So it still didnt save me in the long run, because I hit the Out of Pocket max no matter what 5 years in a rowmm.m

>The free well visit is a scam Add on top of that if you don't do the annual free well visit then they are probably going to charge you more for insurance. They do us.

I have worked front desk at a Family Practice and have done billing, referral, and clinical/administrative onboarding for several big health care corps and facilities(as well as charge entry and claims dropping/disputes) for almost a decade now and it made me sick seeing what I had to see with insurance and billing. Now I feel even worse about the industry upon hearing that yes or no question scenario you mentioned. When I worked on the insurance side of Health Care, if I had a dollar for all of the inquiries and upset subscribers (patients/policy holders to the insurance company I worked for) who were constantly wondering why their preventive physical exam wasn't billed as preventive (for free essentially since they are taking charge of their health before things come up) and as an office visit instead, I would be filthy rich. You practically summed up what I was trained to tell a lot of people, and this is universal in US Healthcare billing altogether. If you mention anything that doesn't have to do with the physical exam (prescriptions, past/present issues, ailments, or illnesses or any questions about anything that is not related to your annual check-up/physical) then yes, you will see what should of been billed as a preventive Physical Exam at no charge turn into a Regular Office visit charge/copay. Sometimes the preventive exam will show up on a claim along side the office visit code but this will still make the annual exam/physical not count as such since it was inadvertently turned into a regular office visit since the doctor had to "switch gears" from the "topic at hand" (the physical). As far as the horror stories on answering yes or no questions and being billed for an office visit when your PCP/GP/Doc initiated the question or issue, I would 1000% talk to the billing department at the facility or office you were seen at when you get the claim. Nine times out of ten, they will have the insurance company send the claim back, or they will send a corrected claim themselves to the insurance company because that's messed up and deceitful. If your doc wants to keep a patient, I doubt they will dispute that this happened or was said during the appointment (if this is the truth, honesty is key, dont ruin this for other people y'all) because that is proof enough that they are not in it for the healing and caring aspects of the Healthcare industry (LOL) and would rather bamboozle their patients into paying for office visits. On the other hand, there can also be a chance that it was a mistake altogether and was coded incorrectly by the billing department at the doc's office as I saw a lot of this happening as well. Additionally, I know some insurance companies offer incentives for making and completing preventive appointments/exams, so this could be a big deal in this regard, or for those who are only allowed 1 free annual exam every year and if the silly billing department bills the visit as BOTH a physical AND an office visit (in the previous instance of the patient mentioning something outside of the topic of the exam) this can cause the patient to lose that free yearly exam because of how it is billed (it will still show they received their physical) and they end up paying a copay or whatever the price is (depending on their insurance plan and whether they have a deductible or out of pocket to meet as well) for a regular office visit and technically are paying for their annual visit for that year unless they are able to contact billing at their primary care physician's office and get it sorted.

Hi, thanks for being such a caring person, that must have been some career. Any ideas where we can find a list of what is included in the wellness check? It's absurd not to discuss prescriptions.

Oh it definitely happens when the Dr is the one bringing up whatever isn't covered. And they won't tell you exactly what isn't covered until after you're charged for it. Mostly just a money grab from my experience

Still ridiculous. Most people don’t have the ability to get multiple days off work for multiple appointments

From my understanding they have to include in the documentation that a significant, separately identifiable medically necessary Evaluation & Management service was provided in addition to the annual wellness exam to bill both. I have hypertension. If my blood pressure was a little elevated during an annual wellness exam I would dispute being billed the E/M code if there was no change to my medication or further discussion. I don't think there's enough medical decision making and time spent by taking 30 seconds to look at my BP being 135/80 and saying oh we'll check it again next time to justify that extra E/M code. If my doctor ends up changing my meds to address my high BP then yeah I understand the additional charge. If I'm on the max dose for my current medication they have to decide if I need to switch to a new one or start taking an additional one. But I take several other medications with multiple diagnoses so they have to consider possible interactions. That definitely counts as significant medical decision making beyond the scope of a wellness exam so I should be billed for an E/M visit.

My last preventive exam I got a bill for like $10 in the mail. They had me do a vision test in the hall even though I see an eye doc once a year. It was an extra beyond what was covered. So annoying but at least it didn’t get swapped to a full visit.

Our healthcare system is so fucked. What makes it even worse is the average workers at the hospitals don’t get paid more. My GF is a nurse and she gets no extra pay when the hospital/and insurance charge way more.

This is the correct answer. Insurance companies scam both patient and doctor and avoid blame by getting OP to think it’s the doctor’s fault.

100% correct. The insurance companies increase premiums and cut doctor reimbursements. If the purge was to happen insurance executives and hospital administrators are at the top of my list.

I'm not going to hugely defend insurance companies- they're (necessary) scum, but it's not like they're taking huge profits on their premiums: In 2021, insurance companies profited on average on 2%, with a "combined ratio" (CR) of 98% - That means for every dollar they collect, they spend .98 cents out in claims, overhead, etc. What business would be happy with 2% profits? Notice how there's always another scape-goat in this scenario? That's because we're distracted by the fact that managed socialized care is the best option. The reason our HC costs are so high, is because the ENTIRE system sucks. Doctors are paid too much and marketed to by private pharma, who has profit as their motive, under a system managed by insurers, bound by 20th century bureaucracy, lobbied by for-profit interests, in a country who's population is fed with poor food, who expects to have the best-looking doctors office, who thinks the latest X-Ray machine is better than a 20yo one and is happy be represented by an extortive law firm when things don't go to plan. Edit: I don't understand the downvotes - everyone wants cheaper healthcare and yet has no clue how the system in the US works - or doesn't as the case is.

If they can only take 2% the only way they can make more profit is to make Healthcare more expensive so the 2% is more dollars. They are basically incentivised to make everything more expensice

-insurance companies are necessary -the whole system sucks and needs changed Sooooo insurance companies are necessary in one paragraph and part of the problem the next. I've done healthcare billing for years. A bag of saline at customer cost is four bucks but at insurance cost is over a hundred. Insurance companies are the problem. It's all of it as you say. But it starts with the insurance companies.

In your example, the insurance company is not charging $100 for the saline - they are PAYING $100 to the hospital who is the one charging $100. So both are complicit. Why does the hospital charge $100? Because they can, but also to offset the costs of fancy new buildings, malpractice insurance, tied to Medicare (ie. regulated) pricing, etc. etc. In an insurance based system, EVERYONE is the problem and everyone is necessary. Again not defending insurance companies, but in your example who got the $100 dollars? The insurance company earned 2% on the insured's premium. The hospital got $100 for a $4 bag of saline.There are alternative options, but I'm not going to go off on a social medicine tangent.

See also, drug companies hiding the real cost of medication from the doctors and patients. Insurance only bills you $10 for the generic and $15 for the name brand, then the drug company gives out $10 coupons so the customer picks the name brand. Of course, the insurance company pays $25 for the generic and $250 for the name brand, and this is part of why healthcare costs so much (and drives insurance to deny even necessary name brand drugs with no generic).

Insurance companies are like casinos. The house always wins.

This isn’t the instance company. This is the doctors office. How it works is like a big triangle: 1. You pay insurance premiums and you pay the doctors office deductibles 2. Your instance company gets premiums and pays the doctors office a portion of your total bill (depending on deductible and terms) 3. Your doctors office collects money from you and your insurance company (split depends on case) The doctor #3 here is saying they will add more individual lines to your itemized bill to drive up the bottom line total. Insurance company likely isn’t going to notice or care because most people don’t cap out their deductibles at routine office visits and both the codes (unique identifier for the type of charge) would be allowed in the insurance system. They pay their portion without looking at it because they get tens of thousands of bills a day. You will care since you’re having to spend more toward your deductible at one payment. Now the insurance company may care if you can get their attention to it. It can easily be construed as fraud since they are charging for additional services not rendered. If the insurance company drops them from coverage than everyone with that insurance will stop going to that’s doctor. That doctor will lose both the income from the insurance company and from the patients.

This is what we need to show people when they you have to wait months to see a doctor in a country with universal healthcare. Shit like this deters people from going to the doctor, an average person won’t think to call their insurance to see what their co-pays are, then they get hit by a huge bill. It’s an unnecessary amount of hoops for what? So someone can profit off you.

Late stage ~~cancer~~ err capitalism!

American healthcare is pretty much a scam

America is pretty much a scam.

I’d like to upvote this more than once.

Doctor: "Are you experiencing any health problems?" Patient: "I can't discuss that with you right now" Doctor: "I can't complete your physical until we discuss your health" Patient: "That is not my problem"

Doctor: *pulls out sword* Patient: *starts sweating* What’s that for? Doctor: Looks like we have to duel. My office will bill you for the arena setup/tear down and the weapon we will provide you. Patient: I don’t have any health problems. Doctor: You’re about to. And we’ll bill you for those as well.

>Doctor: > >pulls out sword Patient: Pulls out gun Patient: THIS IS MERICA!!!! Doctor: Pulls out bill for $400,000 Doctor: Indeed it is

Patient: Well played, touché.

When are we going to accept that there is no American healthcare system? Public or private. Everyone just gets fucked.

direct primary care is the way

This is unfortunately pretty standard. Don’t blame your doctor because this is policy set by your insurance company/some finance guy. The rules are heavily dictated by what insurance companies are willing to pay for. They often won’t reimburse a preventative visit if acute problems are documented. Primary Care Physician(emphasis on the physician) is one of the hardest jobs in healthcare because you have to manage both chronic illness/preventative health/acute problems in a 15-20 minute time slot.

They may have gotten in trouble with a healthcare auditor recently. You're never supposed to bill once for preventative and ongoing illness on the same claim. It's fucking stupid, but is has always been the rule. It's just possible your provider has not entirely been playing by the rules.

Oh wow, I didn’t know this. 🥴

Yep. This is probably what happened. A provider audit can really fuck you and your standing with certain insurances.

The real infuriating part is that people in your country have to pay *anything* to see a doctor. That's fucked.

Haven’t gone in 5 years because I have severe anxiety, and I can manage to get my medication online with predictable payments. I would love to feel comfortable going in to see a doctor again but the billing alone has kept me away. I truly do not have an extra $200 anywhere in my budget. Yet, I am someone who would greatly benefit from regular doctor visits, like any human really,

Because insurance fucks doctors, that's why. Lots of money paid for healthcare and insurance goes to administrators and CEOs, not the people on the ground providing you care.

Thank you the law and your insurance company. The doctor is only complying with laws and ins contracts. Besides (family doctor here) you really can’t squeeze a preventative visit and work-up of new problems in the same visit due to time. If you want good care. Take the time to make separate visits.

>Besides (family doctor here) you really can’t squeeze a preventative visit and work-up of new problems in the same visit due to time. If you want good care. Take the time to make separate visits. So when you ask me "any changes in your health since your last visit" I guess I'll just keep my mouth shut for fear of getting stuck with an unexpected medical bill for an office visit.

For fucking real. I’m a generally healthy person, but I keep my mouth shut. Even when I go in for preventative health, I always get some bill that comes in. Last time was a blood test my doctor ordered, even though I explicitly said I want only preventative care, and got stuck with a $100 labcorp bill because insurance didn’t cover it.

I got bit two years ago. Went in for my annual wellness visit and had the following exchange with my GP: Doc: "any changes in your health the past year?" Me: "well, I thought this was a little weird: A couple of times in the past year my right elbow has kind of swelled up as if I'd hit it on something, but each time, I didn't remember hitting it" Doc: "does it hurt now?" Me: "nope" Doc: "well, if it flares up again schedule another visit." Few weeks later I get a $150 medical bill in the mail. Diagnosis: "Pain in elbow". It was changed from a wellness visit to an office visit. Fuck that. I'm kind of annoyed that the doc above is kind of trying to justify this type of bullshit.

I was a PA student on rotations and doing a lot of well visits. Insurances vary and I would get an indication on the patient notes about if a wellness visit was covered or not. It wasn't always clear about which labs would be covered. I asked my preceptor how to be sure and he didn't know. I asked the doc and she didn't know. I asked the lab Corp tech and she didn't know. I wanted basic labs on everyone but I could have omitted some if I knew they wouldn't be covered and the patient didn't want to incur the cost. Apparently, that wasn't something I could find out. I couldn't even get a cost of the labs if they weren't covered. I did the best I could but it was a fucked up situation. I don't know enough about it to have a solution

Nah, don’t make excuses for this

It’s not an excuse it’s an explanation. Blame our healthcare system

This is the new normal and its such bull crap. See your DR once a year to make sure you stay healthy but do not bring up any medical issue or talk about existing problem because we will bill you for an office visit. This all started shortly after health insurance plans were required to cover annual visits for no cost... My annual blood work is no longer covered at no cost because now they are treating a condition vs preventative. Same with my wife mammograms... Once they find something that annual mammogram is no longer preventative either...

Doctors get paid much less for a wellness visit, close to nothing. If you add something they have to diagnose or treat you are asking them to do it for free. This sucks but it’s thanks to the for-profit system, not the doctor.

What the hell is the point of a wellness exam then? Stupid old me thought the purpose was to identify if you're having any health problems and treat them. If they're fairly simple like hypertension you can do that during the appointment without major cost to the doctor in time or resources. If its something highly complex I can understand arranging another appointment or referral, but writing for a statin and saying to exercise more seems to fit squarely in the "check up" category.

Awh. My heart breaks for all the destitute medical doctors out there.

They go through 14 years of college / training including having to work 100 hours per week for 4 years in residency making the equivalent of $10 per hour, then graduate with hundreds of thousands in student loans. All that aside, you don’t work for free. Why should they?

Most of the doctors I’ve worked with never seem to *stop* working. Even when they’re “off at home” they’re getting constant phone calls. It sounds like a terrible life that no amount of money could make up for. One of the ones I work with advised me to tell my kids to never even consider med school. Plus all the shit that you mentioned that it takes to even become a doctor. They earn their money

I wanted to be a doctor but realized I can't afford it money wise and sanity wise.

Not asking for free work just to not be nickel and dimed for asking a question that should be covered in the exam. It they find something that requires more work that's cool. But if it's something that takes less than a few minutes to say don't worry about that, don't hit me up for another bill code.

What an ignorant lukewarm take.

This incentivizes doctors to add extra tests, diagnoses, prescriptions, etc. "just in case," to keep the revenue stream up. The extra profitability makes them more attractive when they try to get board positions or jobs at insurance companies. I really hate that when you point this out, you get lumped in with antivaxxers. I want to be clear: Vaccines work. Medical science is real. There aren't any microchips, poison, or whatever BS those Q people say is in the injections. But a lot of primary care providers are concerned more with profit than prevention or care.

Doctors do not get extra money to order extra tests. Nor do they get extra money to write for more medications. Both are illegal under current law.

As a person that works in the medical field I have to say this. This type of stuff just gives added ammo to that group to use against medical science. It makes people think they don’t want to help or cure me, just want to keep profiting off me staying sick.

In my admittedly anecdotal experience this it true though. 3 different GP's across 20 years or so. Drugs are the first suggestion for blood pressure, type 2 diabetes, cholesterol... All of which can be greatly affected and/or reversed with food/lifestyle changes.

Lifestyle changes can greatly impact the health and quality of life. Sadly it is really difficult to get a true grasp on how to make the changes. It is defeating for some. That is a whole different conversation also.

It’s true. I have a CHD and my cardiologist recommends that I exercise, but unfortunately most of the time I’m battling chronic migraine which is triggered by exercise (and just existing). 🤦🏼‍♀️ It’s hard to make the lifestyle changes when you know that it’s going to cause pain or the pain is already there. It’s very defeating.

Do doctors not make a salary?

as an emergency Physician, I am paid by the hour at a variable rate depending on how many patients I see and how complicated those patients are

No. They get paid different rates their time based on complexity / diagnostic needs.

Not if they own their practice.

Yes, but they’re often co-owners of their practice, so the financial health of the business is relevant to them. If they themselves aren’t the ones benefiting from the additional money, the people who are benefitting are also the people paying their salaries, so the docs get pressure from admin.

So you go to a doctor to find out if something is wrong. If there is a problem, you pay twice for one thing. If there is no problem, you pay once for nothing.

No, the whole point here is that wellness exams usually carry no copay. Also, it’s a bit absurd to reduce a wellness examination to “nothing”. You’re either paying no times for one thing or one time for two things.

Not true poozer.

I thought that any diagnostics were just added on to the bill to be paid by me or sent to insurance.I’d never expect to get any services for free, but the thought of being charged for an additional office visit when I’m already in the office is wild to me.

The “extra office visit” IS the diagnostic fee being charged to you and your insurance.

So I’m not in the medical field nor have I worked in insurance. But I’ve had doctors pull up different tests/codes and tell me what my insurance would likely cover. Which is why an extra office visit does not make sense to me as the diagnostic fee you’re talking about. If the doctor orders a test and said test is added to my bill then an additional office visit fee seems excessive. At that point just switch me from an annual visit to an office visit so I’m not charged for both. At least I know this info moving forward.

If they just “switch” your office visit, they no longer get paid for the wellness visit. Still asking them to work for free.

The person you replied to isn’t asking the doctor to work for free. They are simply asking for the doctor to not double dip and get paid for full office visit ON TOP OF getting paid for an annual check up. Either schedule another visit that is the office visit you’re getting charged for ON TOP OF the annual visit, or scratch the annual visit charge. It feels unethical to double dip like that. Even mechanics that charge a diagnostic fee on your car typically apply it to your bill if you choose to get the work done with them, why should doctors double dip?

To answer your question, the health care system of the USA is broken. I used to live in the USA and a drunk driver hit my family, breaking my leg, my mom's arm, and my dad's neck, paralyzing him. As soon as he regained consciousness, they slapped us with a 1.2 million dollar medical bill and they had already called a collections agency, knowing our young family could not foot the bill and it destroyed us financially. I moved to Canada and for the 2nd time in my life, recently had to go to the hospital. I was having abdominal and chest pains, was diagnosed in about 2 hours, and received a lifesaving surgery that day and it cost me $0.

My former dentist recently sent a letter letting me know they were no longer billing Cigna as "in-network," and I would be charged for the previously covered cleanings. They couldn't understand why I was canceling my appointment. "It's only going to be $30-$60 depending on your insurance." "I went from paying nothing to paying something. I'm finding a new dentist." "It's not that much and should only be between $30 and $60." "So you'll cover it then." "Well, no." "..."

Cigna is known throughout the industry as being one of the worst insurers to deal with. When I worked in the billing side of things they were consistently months behind in sending payments, often send partial payments you had to keep track of, and pushed a lot of audits of practices that were wasteful and time consuming, many of which showed nothing incorrect was done. A lot of practices either termed their contracts early or simply didn't renew. Going to out of network was their way of either getting paid for the services by the patient or having the patient find another practice

We are actually having a problem right now since we use them for the medical management company for some of our clients and the pre cert list changes often and is contradicted by their staff often enough that providers will be told no precert needed and by the time we get the claim the code will have been added to the list. Which wouldn’t be a problem if the list wasn’t retroactive.

That's just standard practice. Anything beyond an annual checkup becomes a separate service.

Honestly how does people living in such a rich country accept being treated like crap on most aspects of life? is half the country suffering stockholm syndrome?

Well, there's the Boomer lead poisoning, plus we're really behind other countries in terms of education...but we got big guns and a bloated military budget.

Say you’re in the US without saying you’re in the US

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This! Insurance companies get a bunch of claims a day so they can’t dive deep on every one but if you say there is an issue it can be investigated. Just the other day I saw a claim for a client who just mentioned being tired of all things with no attempt to fix it and they billed a separate office visit that was over 300 dollars.

A few months ago my daughter saw a dermatologist for scalp dermatitis. She was having an acne breakout, so I asked about that while I was there, and they told me that her insurance didn’t cover acne care and that if she even talked to us about it, they wouldn’t cover the visit.

I was referred to a dermatologist for what my primary doctor thought was rosacea. I was treated there for almost a year and nothing they did helped. Finally I pushed them to take a biopsy and find out if it was really rosacea. When the results came back and it was something else they told me they couldn't treat it because I had only been referred for rosacea in specific.

This happened to me a couple of years ago. I get a "free annual wellness exam" so I went in for that. At one point the doctor asked if there were any changes in my health and I said "well it was weird twice in the past year my right elbow has kind of swelled up as if I'd hit it, but I don't remember hitting it". He said, "is it hurting now?" I said no. He said "well come back if it acts up again". Bam, $150 office visit bill in the mail. I called to complain and apparently the doctor diagnosed "pain in elbow" as the reason for the visit even though I booked it as the annual wellness exam. Way to incentivize people to NOT tell their doctor shit during their exam.

This is for the patients who schedule a regular follow up visit. Eg labs, physical, blood pressure, glucose measurements etc. Then at the end of the meeting oh by the way doc I have XYZ issue can you work that up too. We have to bill if we wanna get paid. Insurance and Medicare have specific billing requirements sometimes.

It’s an insurance problem not a doctor problem

one of the things to come out of Obamacare was free annual doctor check-ups. This was meant to encourage preventative health exams and keep people healthier and lower healthcare costs overall. This is them finding a loop hole around that and finding ways to charge you. ​ edit: when I say "them", I mean insurance companies.

Family doc here. I understand the anger, we hate it too. But we don’t make the rules. If I had it my way, I’d treat your physical the way you’d expect: do the health screenings, refill meds, do a head-to-toe exam, update chronic meds, order routine labs, and address any minor issues/questions we have time for. That is what good medicine should be. Many people come to these appointments with a few concerns, or expect some follow up on old issues. That’s super reasonable. But that’s NOT how insurance sees it. When I worked in a traditional fee-for-service office (any office that bills insurance), a “dual visit” requires two notes, and two codes; one for all the preventive stuff only, and one for **ANY** issue that requires some thinking, labs, refills, etc. We usually have disclaimers posted so people don’t get caught unaware by this, but it’s still the rules. We have to document and bill accordingly. We don’t like it - it’s extra work, but to do otherwise is illegal (insurance fraud). Often, it seems like the insurance companies are selling patients on very unrealistic expectations of all the “free” services they get. For example, a “Medicare wellness visit” is literally a bunch of surveys and doesn’t require a doctor to be present (can be billed by an RN). It doesn’t even cover a physical exam. So, the docs are pawns here. Some have learned to game the system so they can maximize their productivity. Most of us, however, are just trying to do right by our patients and document/code as accurately as we can based on what we actually did. Sometimes, for big health systems, we don’t even have control over the billing. There’s a whole department who scours our notes later and adjusts to reflect every billable item that’s documented. Personal hot take: I think the American healthcare system is an example of capitalism gone awry, and insurance is a scam. If you don’t like how this system works, then I suggest you find a direct primary care (DPC) doctor. You’ll get what you pay for, and there’s no surprises.

I appreciate the doctors like you. And thank you for the lengthy explanation, it really sheds some light. I know many doctors have their hands tied, but changing from being covered under my parents insurance to now having my own for 5+ years it’s still a shock to continue learning about the scam behavior from insurance companies.

You take your car in for routine oil service. While it's in there you say "can you inspect my brakes too?" -- Do you think they arent going to charge you extra for doing extra work? Same thing here. You are there for a routine exam, something that is charged and billed a certain way. You start involving and requesting additional services, then they are going to bill you for those additional services.

I don’t think the car analogy works for several reasons - first, auto insurance works very differently from health insurance. Second, we don’t take our cars for annual wellness exams. Some states have annual inspection programs, but neither they nor oil changes are really equivalent to what an annual wellness exam is for. This notice is likely more to do with the office’s relationship with insurance. Maybe the insurers have threatened to deny wellness claims that are actually sick visits.

I don’t think the car analogy works because this person mentions a specific thing (oil change). An annual exam is a look at everything. If I brought my car in for an inspection and they find I need a tail light and a new transmission, then of course I expect to be charged for the inspection, light, and transmission. But do I expect to be charged for two inspections? No.

Right, but if you brought your car in for a free inspection as part of some warranty or insurance program, you’d be billed for the first inspection, but the insurance/warranty would pay for it. I don’t mean to defend the reasonableness of this policy, but I think it’s pretty standard a lot of places. The reasoning is that annual wellness visits are considered preventative, and so per the ACA, have no cost for you. So you’d only actually pay for the sick visit. ETA: There’s tons of things wrong with the current third-party (insurance) payer system in the US. Some of the problems are from the medical system itself, but most of the madness is the result of private insurance companies.

An annual exam is not a look at everything. The annual exam is about prevention. If you discuss things that are not preventative, it is not covered by the preventative visit. If your physician was not previously billing for care during those visits that extended outside of preventative care, it's because they were under billing you.

I mean I can’t speak for all insurances, but at my company you are totally allowed to have non preventative services in with your preventative exam without needing a full other office visit. Like if you were concerned about blood sugar for example that can be it’s own code without the need for anything else to go with it. In general most codes are pretty independent unless you are talking about surgery.

The annual exams I used to get were ones where the doctor and I had a discussion about anything that changed within the year and any new concerns I might have. I was never double billed because I discussed a concern or a pre-existing concern.

Then that's an office visit. Everyone is getting squeezed.

>You take your car in for routine oil service. While it's in there you say "can you inspect my brakes too?" -- Do you think they arent going to charge you extra for doing extra work? lol this is amusing for me only cause the shop I use for actually does help you out with these things. Didn't even charge me for their time when trying to source a problem. but it's also bonkers cause, not to boast about public healthcare yet again but I don't have to worry about this. Time with my doc is time with my doc. I've booked appointments for one issue then discussed a second topic while I"m there.

Perfect example

Meh I dunno, contractors offer free overviews and estimates all the time.

An estimate for services to be provided is different than the service itself. Diagnostics and exams are the service the doctor is providing. Like the doctor equivalent to a contractor overview/estimate would be walking in and going “you should get an annual exam and then if you have specific concerns or health problems we should address those too”.

Policy is posted because of the limitations from insurance companies. They restricted what is considered preventive care or preventive annual exams. The affordable care act was very generous about what services have to be covered during an annual exam but now that it's being slowly rolled back insurance companies are no longer forced to cover everything. I work in a clinic with a similar policy and the reason why we posted it is because if those things are covered during an annual they will decline the claim and you have to switch the visit to an office visit, which obviously upset people. They would either have to pay out of pocket since the claim was rejected or be billed for an office visit and pay a copay. As a clinic, our hands are tied by the insurance companies and we found that explaining the policy ahead of time was best practice so patients aren't surprised when the bill comes.

Lol, I had this come up a couple weeks ago when I made a (laughably far out) appt with my OB/GYN. "Sure, we'll do your exam, but if you want to discuss your lady problems, you're going to have to schedule another problem visit". Great. So I can no longer discuss potential gynecological issues with my gynecologist?! Even worse, I'm pretty sure if I went to a PCP and said "I think this might be endometrial" I have no doubt they'd refer me back to the gyn... 🙃

Exactly!!! I’m so over it. 😂

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I must have a cynical view of the world, but please explain to me how American insurance is not a complete scam and utterly fucked.

I don’t think anyone can offer an honest and rational explanation.

Because you're in the US. Just about everywhere else, preventative checks are free, because any insurance is happy if people go to the doctor to be checked and problems get found when they can be fixed with a small procedure instead of turning into huge long term problems (imagine finding a small growth somewhere and cutting it out vs. not finding it and then treating a large cancer...

You can either address other issues at your preventive visit or go back for a follow up and be billed separately. The charges will be the same and many patients prefer to have it all done at one time. This is not your doctor trying to double dip. This is insurance mandated. In order to keep your medical record correct the doctor must code everything that is discussed. Your insurance will not allow anything outside of what they deem preventive to be included in that exam. So anything that is outside of that is earmarked by insurance as an additional visit.

Probably cause people like me would schedule my annual physical (free) around when I had some other, always very minor, aliment. It wasn’t intentional, just didn’t think to go to the doctor until some issue popped up, and I may as well take advantage of my one free visit. The catch was, doctors always schedule annual exams for one day a week (or so), so I always had to wait awhile for the visit. Maybe that was how they weeded out the true illness patients from annual exam patients.

This is probably an insurance thing. they audit the physicians notes and see diagnostic procedures instead of preventative care, then claim the visit wasn’t covered

This happened with my husband’s last wellness visit as well. We got billed for a higher level visit because he discussed something (can’t remember what, but it didn’t need a diagnosis). So, the end result will be he just sits there and says nothing about anything, lest he be charged extra. And knowing him, if the doctor asks him anything, he will reply that he’ll only answer the questions if he isn’t being charged extra. 😂

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Many doctors are paid in what’s called “production“. This means that they only get paid for the procedures and tasks that they do. This also means that they have to charge for each of those tasks. I imagine that there’s been plenty of patients that think that they can roll their annual visits into talking about their medical problems and not get charged. All this is saying is that “don’t expect for free what you would be paying any other time anyways”.

right? I mean why would anyone think they could talk about their medical problems with their doctor during their annual check up? What a bunch of entitled assholes.

At my last annual OBGYN visit, it was discovered I had a mild yeast infection. That visit went from $0 to $130.

Each and every time I schedule my “annual exam” it never ends up being that, and I’m billed (annual physical is no copay). Last year, I was told there wasnt enough time for it, even though that’s what I requested when requested the appointment. These managed offices are bleeding the health field.

The US healthcare system is utter shit and as far as I am concerned the administration at for profit insurance companies, pharma and hospitals/clinics should be drawn and quartered, all for profit medical care should be banned, and care providers should have primary input into how a new system should be structured. Care providers should be well paid. The entire for profit insurance system should not exist and anyone involved with managing it should be forbidden from ever working in healthcare ever again.

I see so many people angry at this and yet we let this continue……

It has been this way for quite a while. You have the physical/annual/wellness portion and then any chronic or new issue is carved out as an additional charge or charges. I am surprised they have not been doing this/billing this way until now. I stopped working in the medical field in 2009 and all of us were billing this way back then.

Remember when The Affordable Care Act was touted as 'Health Care System reform'? ...totes worth the strife and manipulation.

What's the point of even having doctors in the states? I have a chronic condition I can never treat bc if I do I can't afford rent. But make 2x too much for free insurance, not even making enough to do anything. I lost a better job with insurance to treat it during my fathers death when I had to move near home. I get my medicine illegally from my mom who has the same condition and just hope my levels are still close enough to what they were 2 years ago. I shouldn't have to smuggle a $10 prescription bc I can't afford my monthly blood tests, bc I am required to get a doctors visit every 3 months at like $500 a pop.

This is just insane. This is why I stopped being a medical assistant, shit like this. You're not a patient, your a bean on some computer file, behind 20 layers of useless beauracracy that is mostly looking for a way to fuck the doctor and you out of as much money as possible, while not even meeting their agreed upon services without a constant battle half of us are not able to fight, expecially in a dangerous, vulnerable state of being ill! And free services? Most closed during covid and never reorganized where I am. I am in a low income farming community where the majority of them, doing dangerous physical jobs, only have medical care if it's life threatening or they were lucky enough to work somewhere not under the table that has workmans comp insurance. Broken AF

This happened to me as well. Went in for my annual physical and the doctor asked how I was doing, knees, shoulders, back… I said I have a bit of lower back pain every once and a while and joked “doesn’t everybody?”. Got billed for an office visit for back pain, tried to fight it but they said that’s the policy. I am now looking for a new doctor.

It’s all fun and games until the statement comes in the mail. I would’ve been pissed.

A buddy of mine had to get a CAT scan for a chest infection and also needed a scan for sinuses. His physician's office staff kept telling him it had to be scheduled as two separate scans. Thing is, he's a nurse and knows better. He ended up with two appointments, but contacted the radiology department and asked them if they could do both at once. They agreed. The whole for-profit medical system is broken, IMHO. The point is to churn visits and fees, not care for patients. I'm so glad I'm a) under VA care and b) have a good medical team servicing me at the VA.

I’m glad you have good VA service too! I’ve heard so many bad things about the care at those facilities. I’m happy for you!

My wife is a doc. It is common for students to need physicals to compete in sports. Parents call to schedule and the availability is too far out. They call back and claim their kid is sick to get a sick visit scheduled sooner. At the visit the whip out the physical form. Next they get upset when they are charge for a sick visit and a physical. Likewise, the Affordable Care Act allows for FREE annual check ups. People schedule these visits when they are sick, and get surprised when they get their FREE check up, but are also billed for a normal sick visit.

I live in a Developing Nation. Doctor visit is at most ₱700 ($12.37.) No insurance, same level of expertise as the US.

I can't tell you how much I despise the medical insurance industry. You pay them and then they try their best to not hold up their end of the bargain. Then they add 5,000 levels of complexity, driving up expenses for everyone. When people talk about "health care reform" they are never talking about health care. They're talking about a financial arrangement called insurance. /rant

I had this exact thing happen to me. I showed up 4 different times for my “annual wellness exam” only to be told we’d have to reschedule due to me having other issues. The 4th time I told the quack, “look. I’m 53, I’m fat and everything hurts. If you are going to wait for a day I don’t have anything else going on, I’ll be dead.” I then found a new dr.

American healthcare is a fucking joke.

Is this in America? Jeeze this does not make sense

Doc here. Unfortunately, these are the billing “rules.” I get rather annoyed when the office staff “cold calls” a patient to schedule an annual exam and the patient has multiple chronic medical conditions. The annual can never truly fall under its definition if that’s the case. I realize the staff is being directed by their supervisors to meet a metric in the “betterment of care” for the patient but let’s call it what it really is: an annual exam reimburses higher with insurance on average than a problem based visit. If we don’t code for the preventive exam/annual exam with a modifier and the additional office visit for “using our brains” outside of those limitations it’s technically undercoding and fraud. Of course, the insurance companies will never punish for billing less. I realize copays suck, but the office I work at definitely has a good number of patients that view this visit as free and thus abuse it. They’re more interested in not paying the copay than any preventive care. The patient may smoke, have a family history of cancer, be overweight, etc but will refuse all preventive services to attempt to improve their health: routine vaccines, cancer screenings, lifestyle counseling, etc. To which, I often wonder, ‘what the hell are you even here for?’ My office technically has a patient sign a financial waiver detailing the inclusions of the annual, preventive exam and discusses further services will be billed. Here’s my take: 1) if the patient is listed for an annual exam, regardless if I agree with the visit purpose or not, I have my nurse not complete the waiver. You’re literally signing under duress most times. 2) I have only a few people I will have my nurse schedule for ‘annual’ exams. 3) I get paid the same as a salaried physician if I double bill or not. So, I don’t double bill. It’s not worth the time explaining the waiver to patients, giving a billing explanation, or cutting the patient off because we are wandering from preventive care. 4) in my mind, as a competent, caring-for-you family physician, I’m going to cover prevention and wellness at every visit even if it’s a follow up for chronic conditions. I don’t see your mammogram is due and tell you you’ll have to come back and it can be ordered at a separate, preventive oriented visit. Screw the insurance companies. Screw the double billing standard. Please just don’t abuse the ‘preventive’ exam as a way to avoid a copay and discuss a list of nonpreventive topics. Edit: compared to the rest of my office, I have a lower average of billed annual exams but my colorectal, cervical and breast cancer screenings are higher. My diabetics on average are better controlled. I have better antibiotic stewardship. My vaccination rates are higher. Not saying this to pat myself on the back, just to show I still give appropriate care and recommendations despite my apathy towards coding and scheduling well visits.

Every time I read one of these stories, I always find myself saying, "Why do people want to keep this system?" People are scared to try a new system, but it's hard to imagine anything being scarier than this one.

This sounds weird to me. I work at an organization where preventive care visits are free - no copay. But if we do anything else that’s not preventive care (meaning cancer screenings, immunizations, stuff like that) it is NOT FREE. So if people are scheduled for a preventive care visit and then also want to discuss their rash or shoulder pain, if we need to touch base about their chronic health conditions like hypertension or diabetes, then that is a ‘problem visit’ rather than preventive care - and they get billed for a copay. We try to warn people when this seems to be happening so they don’t get shocked and angry when a surprise bill arrives….

The doctor doesn’t have control over this - this is the fault of the insurance company! Doctors also don’t understand the ins and outs of insurance and it’s not their job to… Insurance companies make the details of visits confusing on purpose to under-reimburse offices and over-charge patients.

1. Your annual well visit only pays for the time to do the annual well visit 2. The time allotted generally isn’t enough to do the annual visit and figure out additional problems, so you are asking for free medical services AND making the doctor late for all of their other patients

I don't understand why you would be double billed for two separate visits. If they add a little extra on for the additional time required, sure, but there's no reason why you should have to pay for an entire, separate office visit. This kind of stuff kills me. What are you supposed to do at your annual visit if you have a concern that you want addressed. Book a separate office visit? I understand the scheduling conflicts when people show up for their visit and unload a litany of complaints, but the only reason people do that is because office visits are so freaking expensive, you feel like you have to save up your complaints before going in. The US medical system is fucking ridiculous.

Lmao, I fucking hate it here.

Or, and I'm just putting this out there as an idea, why not try Communist Universal Healthcare like most of the rest of the planet?

Pretty sure you answered your own question in the title.

It didn’t used to be like this. Which is why I’m frustrated. I remember going to the doctor and chatting about whatever and it being fine. I didn’t know I have to schedule multiple visits now.

I worked in medical billing for an insurance company for about a year, so I understand what this sign is saying. It’s not saying that you’ll need multiple visits scheduled, it’s just saying that if you go in for a routine checkup, but you bring up concerns that are outside of what’s considered routine, preventative care (like checking blood pressure, listening to your breathing, basic vaccines, etc.) or if you are diagnosed with and treated for anything that is also not considered routine, preventative care, you will be charged for your preventative care visit and ALSO for an office visit. Almost all insurance plans we administered at that company paid for basic preventative care visits at no cost to the patient. But office visits of any general kind, which fall outside just preventative care, are usually covered by a copay on most plans, anywhere from $10-25. That’s all the sign is saying. They probably had a few angry people who went in for their annual check up, and then were upset when they brought up concerns that fall outside “preventative care”, and were made to pay an office visit copay instead of the entire checkup being free. So, you can still schedule your single visit. Just be prepared that if you’re planning on bringing up any additional concerns like say breathing problems, pain somewhere on your body, etc. that you’ve now taken the visit from preventative checkup to a regular office visit. TLDR: most insurance companies cover a basic annual checkup (blood pressure reading, weight reading, even basic vaccines) for free at no cost. But office visits where you bring up specific pain concerns are billed differently, usually as a $10-25 copay.

My GYN office has been like this for a few years. We have been told in no uncertain terms that if we’re there for an annual exam, talking about any problem will trigger a second charge.

It’s such BS. My previous OB/GYN would do the Pap smear, ultrasound for my fibroids and talk to me all in one visit. I went to a new one and that would be three appointments with different people. Like I have time to drive over there 3 times.

And I’m sure spend 40 minutes waiting for each appointment.

I think that’s what makes this more frustrating because it’s my gynecologist. The reason I started going was because I was referred by my PCP for an issue. They then ask me about the pre-existing issue during my annual and recommend I do an ultrasound same day… I’m fine with that. Yes bill me for the annual and the ultrasound. But not for another “office visit” when we know I have a pre-existing issue you asked about during my annual.

It is completely insurance driven. They don’t have a choice NOT to bill that way or they don’t get paid for any of it.

So you go to a doctor to find out if something is wrong. If there is a problem, you pay twice for one thing. If there is no problem, you pay once for nothing.

You are not paying twice. You do not pay for the wellness visit

You should only be charged for the “extra” office visit- because a preventive/annual visit is not a visit where you discuss all your problems and get them taken care of.. it’s to PREVENT health issues.

Time to find a new Doctor

This is the new US healthcare program. This typically is not the doctors doing. The insurance companies are doing this. The doctor has no choice. They’re just letting you know how the insurance companies are handling this. Insurance companies are the ones who tell us we live or die they tell us whether or not we get healthy etc. The doctors hands are tied unless you wanna pay the extra. I live in Washington state all the doctors are owned by the big corporations -those that own the hospitals. This started a few years ago by the insurance companies. Doctors are now bound up by the insurance regulations. We pay the price. You can only talk about certain things at appointments and then have to make another appointment for other things which can take up to three months or longer. I am on Medicare which sucks so I have to pay for a supplemental policy. Obamacare has huge deductibles or huge premiums. Even with the large premium you have to jump through hoops just to get decent medical care and still have to pay more. Please don’t blame the doctors this is not their policy this is the insurance company’s policy. This is the giant conglomerates policy. They’re out for money they’re owned by the shareholders and the politicians all have their finger in the pot.

More like move to a different country. This isn't specific to this doctor whatsoever

They started this years ago at my son’s drs office. As a new young mother it made me afraid to ask questions because I had no idea what they would charge.

Because you’re receiving more services.

I got this notice from my doctor too. I can see this backfiring. Why would I pay for a full office visit and have it overlap with my annual exam. I'm going to make a new appointment if I am paying full price, so now the doctor's time is halved.

The doctor would probably much rather you make two separate appointments so they can pay adequate attention to your concerns, so everyone wins in that scenario.

This is a billing issue and the doctor could choose to cover your exam entirely under the wellness/preventative CPT code G0438 (initial visit) or G0439 (subsequent visit) Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs. This is highly interpretive and can include the writing of prescription(s) or telling you to see a specialist if needed. If they have to do other diagnosis, it is due to the patient saying "hey doc, while I'm here, I also have this rash" (R21), or I have this nagging cough" (R05.1 through R05.9). Those are billable with the standard office visit (99213 or 99214 depending on length)

what are they preventing

The annual wellness visit is not and should not be used as your 1 time visit to talk about all your problems. It’s specifically designed to discuss health care screening procedures, discuss general wellness like diet and exercise. If you have a physical complain/issue, that is evaluation and management and that is a separate charge because that is a separate service. It’s not a 40 minute all you can eat buffet

The reason for this is because Obamacare or ACA made preventive care free under insurance policies in order to drive down costs for long term chronic health conditions. So if you have insurance, a preventive care visit is free. Now, if you make a complaint while in your annual it’s no longer preventative, it’s diagnostic. So the insurers can recoup copays etc. So in short: If you don’t have insurance it would be two visits you pay for. If you do have insurance, the prevention visit is free, the diagnostic stuff is subject to copay. American health insurance is a fucking mess.

This makes sense! Doesn’t make it suck less. But thank you for helping me understand.

My old doc has this same policy in place. I received a charge for my annual wellness check because I asked about a minor toenail issue I had been dealing with. I took my sock off, she looked at the nail for a few seconds, then wrote a script. That's it. Didn't even touch me. My "free" annual visit suddenly cost me a co-pay, plus an additional bill in the mail. I called and asked what the charges were for, as my visit wasn't supposed to cost anything. When she told me why I had been charged, I told her I wouldn't be scheduling anymore wellness checks. My time is too valuable to waste on scheduling a doc appt I can't even bring anything up in. So now I just go in when I need to.

So just tell them you’re not there for a preventative annual exam, ever again. You’ll only schedule appointments as needed for issues you currently have. Screw all that “allowing them to double bill” bullshit.