Villages Health Lab Fees

[Buckeyephan]

I found out today that whenever you visit the lab at any of the Villages Health locations, they will take your vital signs. That then goes into your profile to be reviewed by your doctor. Because of that, you will be charged a copay because they consider that an office visit. In my case, it was $20 as soon as the blood pressure cuff went on. We do have the right to refuse this if we so choose. I feel it is a total waste of my money. If I'm going to pay for an office visit, I expect to actually have one. According to the person in billing, everyone in the system got a letter explaining this would be done. Shame on me for not paying more attention.

[NYGUY]

I found out today that whenever you visit the lab at any of the Villages Health locations, they will take your vital signs. That then goes into your profile to be reviewed by your doctor. Because of that, you will be charged a copay because they consider that an office visit. In my case, it was $20 as soon as the blood pressure cuff went on. We do have the right to refuse this if we so choose. I feel it is a total waste of my money. If I'm going to pay for an office visit, I expect to actually have one. According to the person in billing, everyone in the system got a letter explaining this would be done. Shame on me for not paying more attention.

My wife and I have both been sucked into this scam. In our case they did ask if we would "like" our BP taken. We felt, sure, why not (no mention you were going to pay for an office visit by saying yes)!! We were told on the QT by the front desk girls to always say "no thanks"!! Those girls are the best!!!

[jojo]

Is this a new practice? I have not had many visits but they have always taken my bp and never a copay.

[NotGolfer]

Must be your insurance. Of course it's their policy (I was told) to take vitals with each visit. I've never, ever had to pay a co-pay with them. I have vitals taken at my rheumatology app'ts too...it's standard with any office call.

[billethkid]

doctor's visits yes it is no doubt included in the office visit rate.
Lab visit for drawing blood....no way!

[junebug7]

Thanks so much for the "heads-up" on this matter. I have had lab work done for years and never once has it been considered an office visit or charged that way. Recently we have switched over to The Villages Healthcare and we like our new doctors very much after the initial visit. This week I went for my routine lab work and when the tech asked me to get on the scale I questioned it and she said that they like to take vitals at these appts. I asked "won't doing that classify this as an office visit?" and she said "yes". I then refused. When I sat down to have my blood drawn she said "good for you" with a little smile. I have my regular office visit with the dr. next week no need to be charged for one I don't get this week also. I am disappointed that they are doing this and makes me feel a bit distrustful.
Again. . .this is why I love TOTV. Your information has helped others to be more aware.

[collie1228]

It's interesting, it doesn't matter whether it's the doctor, the vet or the dentist, if "it's our policy" they generally bill me for it. If it's their policy, why must I pay?

[blueash]

If these reports are true, and I have no reason to doubt multiple similar reports, this is reprehensible. It may not be illegal or fraud, but it is a sad example of gaming the system, finding a loophole, and I hope each and every patient of that practice personally raises the issue with your doctor or non-doctor provider at each visit you have until they stop doing it.

https://apps8.fldfs.com/first/

Is the link for reporting insurance fraud to the state. I don't know that this rises to that level, however a few notices from Tallahassee that they are looking at the issue might help convince them that it is not worth the potential penalties

[graciegirl]

If these reports are true, and I have no reason to doubt multiple similar reports, this is reprehensible. It may not be illegal or fraud, but it is a sad example of gaming the system, finding a loophole, and I hope each and every patient of that practice personally raises the issue with your doctor or non-doctor provider at each visit you have until they stop doing it.

https://apps8.fldfs.com/first/

Is the link for reporting insurance fraud to the state. I don't know that this rises to that level, however a few notices from Tallahassee that they are looking at the issue might help convince them that it is not worth the potential penalties


I was at our doctor (not in that system) for a regular visit and was asked if I wanted a flu shot and I asked if Helene and Sweetie could come over and get theirs too. They said yes. Sweetie said they weighed both of them and took their BP. Hmmm. We could have had it at Publix and not made a charge for a "visit" that our taxes have to pay for. We don't have a co-pay either because we still have Sweeties "decent" insurance that he worked long hours for fifty years for.

[Bogie Shooter]

If you don't like the process..........talk to your doctor. Posting on here will not change anything.

[Bogie Shooter]

If these reports are true, and I have no reason to doubt multiple similar reports, this is reprehensible. It may not be illegal or fraud, but it is a sad example of gaming the system, finding a loophole, and I hope each and every patient of that practice personally raises the issue with your doctor or non-doctor provider at each visit you have until they stop doing it.

https://apps8.fldfs.com/first/

Is the link for reporting insurance fraud to the state. I don't know that this rises to that level, however a few notices from Tallahassee that they are looking at the issue might help convince them that it is not worth the potential penalties

I hope the folks in Tallahassee are spending their time on real fraud.

[graciegirl]

If you don't like the process..........talk to your doctor. Posting on here will not change anything.


I think it is good that these kinds of things are brought to our attention so we can talk to our doctors.

[dbussone]

It's interesting, it doesn't matter whether it's the doctor, the vet or the dentist, if "it's our policy" they generally bill me for it. If it's their policy, why must I pay?


You have to be your own advocate. Speak up and tell them it's your policy not to pay for unnecessary procedures. If they keep it up, contact your insurer, Medicare, and the insurance commissioner.

[raynan]

I did talk to my doctor about it and she wrote me an order to get my bloodwork done at Alliance and there would be no copay. Just for me to make sure I get it done one week before my physical.

[Ruthtomnorma3]

i think it is good that these kinds of things are brought to our attention so we can talk to our doctors.

amen....amen....

[NYGUY]

I did talk to my doctor about it and she wrote me an order to get my bloodwork done at Alliance and there would be no copay. Just for me to make sure I get it done one week before my physical.

This maybe the answer. Request a Lab Order from your doctor for the Lab your insurance covers rather than going to the Lab at your Villages Health Care Center.

[TomOB]

I get charged $20 just for the blood work where I am sent.

[dbussone]

This maybe the answer. Request a Lab Order from your doctor for the Lab your insurance covers rather than going to the Lab at your Villages Health Care Center.

This is an important point. If your insurance plan has a preferred lab relationship and you use a different lab, there well could be a co-pay. And just as an FYI, hospital lab costs are almost always more than a commercial lab like Quest or Labcorp. The commercial labs have much higher volumes and can therefore do tests at a lower cost.

[alwann]

This happens everywhere now, including dentists. As others have said, study the details of your bills and raise questions.

On an initial new patient visit to Villages Health, I was asked if I had had a colonoscopy recently. I answered yes and said the results were fine. My bill said "colonoscopy evaluation: $200."

Medicare and insurance companies are continually reducing what they pay physicians. Medical practices are forced to play a coding game in order to eke out every nickle -- e.g. one charge for talking to you, another charge for poking you where it hurts, and other charge to apply a band aid. It's only going to get worse.

Watch out for the "up-selling," as well. For example, being asked if you want to update your tetanus shot while you're there. Sound like good advice , but also another charge and, depending on your insurance or your pocketbook, could be something to think about before saying yes.

I recently discovered my dentist routinely applies a fluoride treatment after doing a cleaning -- another dubious practice. I wasn't even being asked if I wanted it. The coating wears off in days, and many dentists believe fluoride does little good for adults.

Adding insult, my cardiologist is pushing vitamin supplements, which he stocks and sells, and also promotes his wife's electrotherapy practice as the answer to my back pains.

It is what is is. But I, like many of you, can remember going to the family doctor meant he or she treated everything from a cold to a broken bone in one visit, with one bill. And if father was laid off, you might be able to pay with a chicken dinner and homemade pie.

[OldManTime]

I found out today that whenever you visit the lab at any of the Villages Health locations, they will take your vital signs. That then goes into your profile to be reviewed by your doctor. Because of that, you will be charged a copay because they consider that an office visit. In my case, it was $20 as soon as the blood pressure cuff went on. We do have the right to refuse this if we so choose. I feel it is a total waste of my money. If I'm going to pay for an office visit, I expect to actually have one. According to the person in billing, everyone in the system got a letter explaining this would be done. Shame on me for not paying more attention.

Wake up people, The Villages Hospital will cover there a..s, and charge higher prices than other hospitals, like Ocala and Leesburg. The refused to take me in an emergency situation, and charged me for an overnight stay, knowing I was a Vet, and did not notify them, never, never will i step foot in that hospital again. :rant-rave:

[lovsthosebigdogs]

I went to a new doctor in TV (I am only here in TV since the end of June) and before he would treat anything he insisted on a full blood panel because I hadn't had it done since June. I said it's only been 3 months and you have the results. He said, "Well, things can change in 3 months". Everything was fine 3 months ago. I was pretty annoyed but felt I had no choice. All I wanted was a cortisone shot for arthritis which I have had before with my old doctors back home. I had to make a 2nd appt for this after the results were in. At my 2nd appt the results were in, all is the same as before, I got my shot and I was informed that I had to make an appt for 6 months out and have yet MORE bloodwork as a follow-up or they wouldn't see me again. I protested but they said it's office policy if I wanted to have them as my family doctor. I have never felt this medical blackmail before at any doctor's office ever. I am so disgusted by the doctors here. I also felt it at my vet after she made me come back for an unnecessary bandage check on my dog. I am limited to what practice I can use for myself because I have an insurance company that is not a common one and not many doctors take that kind. Overall, I am not a happy camper about the medical field in Florida so far. I think they are all ripoffs, and that includes the dentist who insisted on a full set of xrays before cleaning when I had them done only 3 months prior. Shame on ALL of them. Where are their ethics?

[kittylecroix]

I also asked for an order for my next blood work after having received the letter from my provider saying they were going to be charging for an office visit for blood work. I also will go to Alliance where I can go without an appointment, at my convenience, and where they provide coffee and muffins if you want it.
The Doctor's office did not object to giving me the order.

[dbussone]

I also asked for an order for my next blood work after having received the letter from my provider saying they were going to be charging for an office visit for blood work. I also will go to Alliance where I can go without an appointment, at my convenience, and where they provide coffee and muffins if you want it.
The Doctor's office did not object to giving me the order.

Believe me, you'll pay for the coffee and muffins.

[Halibut]

The receptionist at my dr's office gave me the stink eye recently when I asked for an order for my blood work instead of having it drawn at their office. They don't charge a co-pay (yet, but thanks for the heads-up!) but Quest is closer and more convenient, plus I can make an appointment there and not wait.

I've also refused to have those repeat, multiple X-rays at the dentist before. They don't like it but nobody's kicked me out.

Enough, already!

[Bonanza]

I think it is good that these kinds of things are brought to our attention so we can talk to our doctors.

But Gracie -- isn't it the doctors who have instituted these "rules" regarding blood pressure, etc.? Medicare may say it's okay, but it sure doesn't sound like an office visit. I don't know what the Medicare laws say, but I smell a fish. It just doesn't make sense to me.

I would call Medicare to see if the simple act of a tech taking blood pressure and not seeing a doctor constitutes an office visit

[Bonanza]

I think it is good that these kinds of things are brought to our attention so we can talk to our doctors.

But Gracie -- isn't it the doctors who have instituted these "rules" regarding blood pressure, etc.? It sounds bogus to me. I don't know what the Medicare laws say, but I smell a fish. It just doesn't make sense to me.

I would call Medicare to see if the simple act of a tech taking blood pressure and not seeing a doctor constitutes an office visit.[/SIZE][/FONT][/B]

[kettlecove]

I just dealt with them on this issue as well. I called to correct a bill I received for a copay for lab work. I told them I have never been charged a copay for any lab work and I have not received notice of changes to this policy from my insurance. Villages Health informed me it was my health insurance's policy. Of course, I will call my insurance but this forum just helped me clarify what is happening. Thank you! It is Villages Health's right to do business that way (which needs to be challenged) and my right to return to Quest when I need lab work. VH was convenient. I can't afford their convenience.

[YouNeverKnow]

I just dealt with them on this issue as well. I called to correct a bill I received for a copay for lab work. I told them I have never been charged a copay for any lab work and I have not received notice of changes to this policy from my insurance. Villages Health informed me it was my health insurance's policy. Of course, I will call my insurance but this forum just helped me clarify what is happening. Thank you! It is Villages Health's right to do business that way (which needs to be challenged) and my right to return to Quest when I need lab work. VH was convenient. I can't afford their convenience.
I noticed on both my husbands and my insurance statements that we are indeed being charged 35.00 for and office visit along with whatever blood tests the doctor ordered every time we have blood work done which is every 6 months. My question is, if we refuse to have our blood pressure taken do they still charge you for an "office visit?"

[Buckeyephan]

If you refuse, they won't bill you for a office visit. That's what I was told by the billing clerk.

[rubicon]

The preceding testimonies support what I have explained for a number of years on this forum and one of the reasons I chose to align with Munroe.

You name it and you will find that its all up selling and squeezing every bit of profit that can be made in this community. Some will label it good business out of affinity or perhaps an unawareness. However, its clear to me that in this community the residents are thought to be a captive audience or perhaps low lying fruit. You know that characterization of rich retirees who can't wait to liquidate their savings and most having medicare and other forms of insurance.

Perhaps some may conclude that this is all being done to obtain the best medical care for residents. If you believe that then you may want to re-visit the standards set by Medicare, your health care supplement, etc.

Personally, I am my own health care advocate. When I first arrived here 8 years ago, The Villages Hospital wanted to charge me $1430 for a procedure I felt could be done in the doctors office and that was only my share and not the insurance company. The doctor did refer me. I was shocked at the price for a room where I would not occupy for more than 15 minutes. I called the surgeon and told him I walked out of the hospital pre-admitting area and that he could do this simple procedure in his office, despite his recommendation. He said it would hurt. I told him I would bite on a stick. He did do it and it didn't hurt. I have no love for insurance companies but I abhor this kind of nonsense more and won't be a part of it

I opine others can decide

[shcisamax]

I am not surprised to see all these comments on how the medical profession has become a profession that is working the system. I am always trying to figure out ahead of time, how they gonna get me. It is sad. You used to go to your doctor as a trusted ally. Now we are on different sides trying to get the most out of our dollars.. and I do believe all these upcharges and forced visits are driving the expanded cost of Medicare. There is also "medical coding" which is how an office gets the most dollars for their charges. That has become a huge area for fraud.

[billybye]

I guess Dr. Marcus Welby retired and sold his practice to Village Health

[Medtrans]

Not sure I understand this practice. Who's taking the vitals, a med assistant, a lab tech, or a nurse practitioner? Seems like the only way an office visit could be charged is if you see a provider, physician or nurse practitioner. I would call my ins company and ask if they know they are paying for an office visit when a provider was not seen. Med records used to have to back up any office visit and I actually thought this is still true today. My understanding is that every visit should (or must?) have a format in which they obtain the reason for your visit, a review of systems, an exam and then an assessment and plan. They must have found some loophole and I find this shameful. I am in the med field and just can't believe they are doing something like this.

[rubicon]

Not sure I understand this practice. Who's taking the vitals, a med assistant, a lab tech, or a nurse practitioner? Seems like the only way an office visit could be charged is if you see a provider, physician or nurse practitioner. I would call my ins company and ask if they know they are paying for an office visit when a provider was not seen. Med records used to have to back up any office visit and I actually thought this is still true today. My understanding is that every visit should (or must?) have a format in which they obtain the reason for your visit, a review of systems, an exam and then an assessment and plan. They must have found some loophole and I find this shameful. I am in the med field and just can't believe they are doing something like this.

Hi Medtrans: How many people actually received their med bills and of those how many bother to read them?. if coded as an office visit who is going to challenge it?

In ,y view a strong motivator for all of this is that medicare is cutting payments to the bone along with private insurers challenging bills. doc need to get pay somehow to mange their offices and meet all the regulations and paper work demanded by both the government and private insurers

[Medtrans]

True Rubicon but if I'm being asked for a co-pay as an office visit and I didn't see a provider then I would sure ask my health ins company about it. IMHO.

[Cobh521]

The Villages health has the patient portal where you can send an email to your doctor. I think the doctors need to be made aware of this practice. They should be able to give you a script to have your blood drawn elsewhere

[gomoho]

The Villages health has the patient portal where you can send an email to your doctor. I think the doctors need to be made aware of this practice. They should be able to give you a script to have your blood drawn elsewhere

I'm pretty sure the doctors know about this. Don't forget they are on a salary and that money has to come from somewhere.

[blueash]

Lots of misinformation/misunderstanding in the posts above.
Physician payments are not causing any significant increase in Medicare expenditure. In fact the last two years, 2012 and 2013 have amazingly had negative growth in payment to physicians per enrollee.

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2014.pdf page 136

Yes there are doctors churning office visits.

Office visits for evaluation and management (E&M) are divided into five levels of service. These are the codes for a typical office visit. Of these 5 codes there is 1, code 99211, which does not require face to face interaction with a physician (or NP or PA).
"“Office or other outpatient visits for the evaluation and management of an established. patient, that may not require the presence of a physician. Usually, the presenting. problem(s) are minimal."
"The medical record should indicate the nature of E/M service that occurred for the date of service being billed. If the service is being provided “Incident to,” the medical record should demonstrate that the service is an integral, although incidental, part of the physician’s professional service. The following clinical scenarios are meant to provide some general examples of documentation that would support billing procedure code 99211, and, is not an all-inclusive list:

A blood pressure (B/P) written down on the medical record does not demonstrate a presenting problem and need for an E/M service. The medical record should indicate why the patient came in for a B/P check (e.g., follow-up after medication adjustment, the previous note in the medical record documented elevated B/P and the provider wrote instructions for the patient to come in weekly for three weeks for B/P reevaluation, etc.).

A diabetic patient comes in for a monthly weight check related to an ongoing weight reduction plan for control of blood glucose levels. The medical record should document that the monthly weight check is an integral part of the patient’s plan of care and that some form of face-to-face E/M occurred either by the provider or “Incident to” (e.g., the weight is documented and the patient was questioned regarding appetite, any associated problems, etc.).

A patient comes in for a renewal of a prescribed medication. The medical record should demonstrate that the medication is part of the patient’s plan of care and that some form of face-to-face E/M occurred either by the provider or “Incident to” (e.g., prescription documented and instructions given to the patient regarding medication, side effects, etc.).

A patient comes in for E/M of his/her anticoagulation medication. The medical record should demonstrate that some form of face-to-face E/M occurred either by the provider or “Incident to” (e.g., the lab result is documented and a note made as to whether modification was made to the medication dosage)."

Clarification for use of 99211 code » Office of Physician Billing Compliance » College of Medicine » University of Florida (http://compliance.med.ufl.edu/compliance-tips/clarification-for-use-of-99211-code/)


The above is from UF website but summarizes well my understanding of the use of 99211. Note it is a service usually done by a nurse or medical assistant, but it should require some physician input. The tricky part of this would be that if the nurse does the vitals and independently realizes they are fine, draws the blood, and signs off the encounter then 99211 clearly is not applicable. If however the office protocol requires that the physician review the information (even though that seems superfluous with a properly trained nurse or MA) the office could argue that 99211 qualified to be charged. There should be some sort of management documented even if the documentation is that no changes in therapy were required. Again, my opinion is that an office which is offering an option of having your weight and BP done when you come for a blood draw, then calling it a 99211 is on or over the line. It is especially so if they are willing to draw your blood without doing a couple of vital signs. Thus they cannot argue that they feel that knowing your BP is normal is an essential component of assessing (evaluating) your ability to tolerate a blood draw.

Again, I would suggest that if you are a patient of a practice with this policy you might let the doctor know how you feel about it, and take your lab business elsewhere or refuse the vital signs.

[NYGUY]

....Again, I would suggest that if you are a patient of a practice with this policy you might let the doctor know how you feel about it, and take your lab business elsewhere or refuse the vital signs.

I agree!!