Preventive Care – How to Talk to Your Doctor

Progressive employers have been offering “preventive” care for “free” to their employees for a long time.  Under the new national healthcare law, “preventive care” will also be included for free.  Unfortunately, I put “preventive care” in quotes because it has hundreds of different definitions, and they vary wildly by plan and employer.  The definition for national health care reform has not even been developed.

Here are some examples of the problems patients face:  1)  they go in for a mammogram, which they are told is free, but it is not if they have been diagnosed with breast cancer; 2) they go for a check up with their doctor, which they are told is free, but the doctor does other things and they get charged with an office visit; 3) they go for a colonoscopy, which is free, but during the exam, the doctor removes polyps and they wake up with a bill for hundreds or even thousands of dollars; 4) they take birth control pills to “prevent” pregnancy, but that is not considered pregnancy; and 5) they take anti-cholesterol drugs to “prevent” heart attack and stroke, but they get billed that they are “treatment” for high cholesterol.

These issues cost patients thousands of dollars, stress and unhappiness.  Doctors get less than half as much money under most plans for “preventive” visits as for “office visits” so they tend to bill the office visit unless you specifically tell them you ONLY want preventive care.  Even then, the doctor makes notes in your file, a nurse interprets those, and then a professional coder translates it into a billing form for the two dozen or more plans that doctor participates in.  The doctor might me in Medicaid (called AHCCCS in Arizona), Medicare, KidsCare, Schip, VA, workers’ compensation, United Healthcare, Cigna, Blue Cross, Aetna, Healthnet, PPOs, HMOs, HSAs, and on and on.  Getting your bill right for your plan is very difficult.

The following is a two page guide developed by United Healthcare and the Valley Schools Employee Benefits Trust (VSEBT) a local purchasing cooperative for their members ran by Tom Boone and Andrea Billings.  The advice might not apply to everyone, but it can give you better ideas for how to handle this important issue when talking to your doctor.  Thanks to them for letting me reprint this advice here.  It is in Adobe format.  You can download the reader for free if you don’t already have it.

100-10173 UHC Talking with Dr FINAL 11-10

If you have any difficulty reading this, please feel free to comment on this page with your email, and I will send you a copy.


2 thoughts on “Preventive Care – How to Talk to Your Doctor

  1. Good to know. Title was a little misleading. But it was still good information to know. Too bad medicine is all about the almighty dollar instead of helping heal people (& pets).

    • You have to remember that doctors have an average of 12 years of college and residency and $300,000 in school debt when they first start out. Most health plans pay them 55% of billed charges, and Medicare pays them only 45%. Under the national healthcare, another $55 Billion is cut from doctor reimbursements. Unfortunately, as a result, primary care physicians are expected to fall short by 80% of the need by 2020. Over 40% of solo practice doctors have had money embezzled by their staff at one point. Doctors in Arizona average over $100,000 a year in malpractice insurance premiums.

      Doctors are either retiring, moving to high paid specialties, or doing non-governmental patients only. That is why they try to maximize their billings, for good or worse.

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