Just Venting A Little
 

For those who pay for their own health insurance. I paid over $15,000 in healthcare premiums in 2016 and had a giant deductable. That is just the way it worked out for me but I'm ok with that. But I thought for that 15,000 I got a yearly wellness check up? Today I tried making an appointment for my 2017 wellness check-up and was told I could not as I had not paid for last years. I called billing FHVC assuming I could clear it up quickly and was told where it was my initial visit with this doctor I got billed instead of Florida Blue. They could not explain to me why it would matter to them who paid the bill, me or Florida Blue Has anyone had this happen to them and if so explain it to this thick paper maker. Thanks in advance

Are you talking about a certain amount that everyone pays, the first of the year for doctor visits? Before it is pretty much covered by insurance?

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.

I thought these exams are supposed to be conducted by your PCP. OP said his issue was with FHVC, did he mean their multi specialty doctors who can be PCP or their cardiologists? They are generally considered specialists and not PCP.