[Villages PL]

Originally Posted by blueash

Contrary to some postings, I believe that the doctor is paid for the visit, not the HMO. It is the HMO which has to pay the doctor. I would like to see more information from the OP, specifically the name of the HMO. Is this a Medicare advantage plan or a private insurance carrier?

This is a Medicare advantage plan: Optimum Health Care, Inc.

I am not aware of any national organization that has recommended 4 times a year routine check-ups. Perhaps the OP could call the insurance company and ask if this call really came from them.

That's a good idea. The literature I read before joining never said there would be 4 "free" check-ups per year. Not even 2 per year.

Four times a year "annual" exams would overwhelm the already overworked primary care doctors. Only explanation I can come up with is that somehow the HMO has you coded as having an illness that should require more frequent visits like diabetes. It is possible the doctor's office entered a wrong diagnostic code on a charge they submitted to the insurance carrier which triggered this call.

Wow, it's getting more interesting all the time. I never thought about the possibility of a wrong diagnostic code. I certainly will call to find out.

Thanks!