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Old 02-14-2017, 08:19 PM
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blueash blueash is offline
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Under the Affordable Care Act, AKA Obamacare, you are entitled at no cost to have one well exam per year. This visit is to review keeping yourself healthy, proper diet, exercise, immunizations. There are particular codes used when billing the insurance to indicate it was a well exam.

A well exam does NOT include management or discussion of problems which you have. Thus if at what you thought was a wellness exam the doctor managed your blood pressure or your arthritis it is no longer a well exam and other codes indicating it was an evaluation and management visit are used. Nor is it a preventative well exam if you came with a list of your concerns, aches and pains, moles, sleep trouble. Sometimes if the problems at a "well exam" are minor enough it may still be coded as well. That is up to the doctor to decide.

None of that matters in the question of whether you are entitled to a well exam this year, you are until the Congress modifies the benefits of the ACA. But the definition of well exam [or preventative health exam] is very narrow.

As an aside, the doctor's office should bill your carrier no matter who is going to ultimately pay for the visit. If you had an office visit last year the doctor may have charged you $200 but if the code used has an insurance allowable of $160, you only are on the hook for $160 and the doctor has to write off the other $40. So they should have billed Florida Blue even if they knew you were going to pay for the visit.
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