I recently had a routine physical that was supposed to be fully covered by my insurance (BlueShield MA). However, I later received a bill from Sharp, stating that my visit had been reclassified as a “diagnostic” appointment instead of a wellness check, simply because I asked the doctor a few questions.
At the end of the visit, the doctor asked if I had any other concerns, and I mentioned my irregular menstrual cycles. Based on that, they changed the visit type, but neither the doctor nor the nurse informed me this would affect the billing.
I’ve reached out to both Sharp and BlueShield, but neither is willing to adjust the charges. Sharp did offer a 20% discount, but I don’t believe I should have to pay for something I wasn’t told about. What are my options now?
That’s right and pretty common. The best approach is to pay the bill and use it as a learning experience.
I had the same thing happen. The doctor asked me a question, and suddenly my annual physical turned into a diagnostic check. What am I supposed to do, stay silent? We really need laws to prevent this, it’s dishonest and just money-grabbing.
It heavily depends on how the doctor or scribe writes the note for the visit and how the medical coder interprets it. If the wording is off, the insurance company might not cover it.
Did you have medical concerns beyond basic preventative care? Yes? Were those concerns addressed? Yes?
If you had gone in solely for those concerns, would you have been charged the same amount? Yes? Then what’s the issue?
If I go to a mechanic for an oil change and tire rotation and then mention my car is making a strange noise, they’ll charge me for a diagnostic in addition to the oil change and tire rotation. Why would I expect it to be any different?
In this case, it’s like the mechanic asking, “Do you have any issues you want me to check?” but failing to mention that there’s an extra diagnostic charge. Not everyone might realize that every additional check will come with a fee.