Health Insurance: Say NO First and Ask Later
Last month, I had my annual physical. I forced myself to do it. To be honest if I am not pushed to go, I can skip several years without doing it.
After waiting a couple of minutes, my PCP — Primary Care Physician — came in and started asking some routine questions. One of those questions was, “Do you feel any pain?. I answered, literally, the following:
“No, but I have a rash and it is a not going away.”
After continuing the conversations for less than 1 minute, she recommended an over the counter cream. The doctor continued the physical. Measuring my blood pressure, auscultation of heart and lungs and finally sent me do the regular blood work. Yada, yada, yada… I am was back home in less than an hour since I set a foot at the doctor’s office.
All commercial health insurance plans in the US, cover 100% of your annual physical. Because it is classified as preventive care. All other type of consultations outside this category go through the normal flow of co-payments, deductibles and/or co-insurances. The combination depends on the type of health plan you have. If you go to the doctor’s office for your annual physical and bring up a question or consultation that is not related to the services stipulated to be rendered during the visit, you’ll be charged separately.
Little did I know that the question “Do you feel any pain?” and the following short talk about a rash would mean being charged separately. I learned that two and half weeks later when I got an invoice for $90. Yes, the doctor recommending an over the counter cream and the less than a minute conversation that preceded it cost me that.
Next time, I’ll say NO and ask if saying YES means being charge separately. Health care services and health insurances in the US strictly follow contracts, policies and regulations. Each procedure/service — CPT — and diagnosis —ICD — has a code associated with it. The conversation you have with your PCP outside the annual physical visit has its own CPT code (99212). If that item appears on the claim sent your health insurance, you’ll be charged.
Fun fact: The CPT code varies by the length of the conversation.
The whole process is far from perfect. You can end up with an unexpected bill if you are caught of off-guard. It is not fair. But you can always say NO and ask. If you don’t know the full length of a contract you are part of, this could a great tactic to consider before making a rushed decision.
