Annual Wellness Visit

Just my 2 cents worth on these "Wellness Exams"......I may have posted my experience on her in another column, and if so, I apologize for the repeat.

I was scheduled to have my exam in Feb. and when a women I did not know called me to schedule this, she said it was not at my doctor's office...it was at an Urgent Care! I thought there might be a separate entrance to this room but when I got there, I had to go through the waiting room to register. It was packed with people with the flu! To make a long story short, I left and did not get my exam. I was furious that my doctor would send me to such a place. I contacted my insurance (Humana) and asked if it was their "rule" for the exam to be done there and they said that every doctor makes his own decision where and how these are to be done. They asked me if I wanted to file a complaint and I said I did. That was the last straw with our doctor. There have been other things that have been happening and we felt a change was needed to get better medical care. These Wellness exams are a rip, in my opinion and I will not schedule any more.
 

Colleen said:
Just my 2 cents worth on these "Wellness Exams"......I may have posted my experience on her in another column, and if so, I apologize for the repeat. These Wellness exams are a rip, in my opinion and I will not schedule any more.
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We, too, have our Medicare Advantage with Humana, and have had good results with the exams. Medicare authorizes a number of preventative exams, and our Humana plan is even better than basic Medicare. For example, Medicare covers a cardiovascular exam every 5 years, but our plan covers it every year once you reach 70. I went in a couple of weeks ago, at our local doctors office, and had the blood work, etc., and the results all came back ok...Blood sugar, Cholesterol, Triglycerides, etc. Then, the plan covers an annual lung cancer screening every year up to age 77....I will be going for a Low Dose CT scan at the hospital cancer center in a couple of weeks, for that test. I suppose a lot of it depends on your doctor, but we haven't had any problems getting our exams.
 
Don M......I'm not saying anything negative about Humana. We've had them for a long time and they have been very good to call and ask questions, etc. No problems with coverage either.

What I'm saying is: our doctor has decided he's not doing the Wellness exams himself. He farms them out to a NP or just a nurse and sends you to an Urgent Care facility, where there's anything and everything going on with people in the waiting room. It was the height of the flu epidemic here and not one person in the waiting room was wearing a mask. I did register and waited about 10 minutes in another waiting room but then I left because I couldn't get past the unclean, germ-ridden place. I was never contacted by my doctor or anyone else as to why I didn't have this done.

Another example of why our doctor is not giving the care he should is: My husband was due for his annual exam last November so I called and made the appointment. I specifically told the receptionist that it was for his yearly Wellness exam. She scheduled him for the doctor's office. When my husband went for his appointment, the doctor asked him what he was there for and my husband told him it was for his Wellness exam. The doctor said someone screwed up and he would only give my husband a short exam. He asked him a few questions and that was that....and charged Humana $309! The doctor didn't even check my husband for his enlarged prostate.

Obviously, our doctor is not doing his job. He use to be very conscientious but the last few times we've seen him he's been very lacks.
 

Colleen said:
Obviously, our doctor is not doing his job. He use to be very conscientious but the last few times we've seen him he's been very lacks.
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I think you've found the root cause for your concerns....you might be better served by looking for another doctor. Your doctor sound like he is using Medicare as his "cash cow".
 
Butterfly said:
The so-called "wellness exam" is NOT an annual physical. It's a whole different thing altogether.
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That's right...the "wellness" visit/exam is an "opportunity" for a person to visit their PCP, and discuss any issues they may be concerned about...and then schedule any tests, etc., related to their concerns. Medicare, and most health insurance plans cover a number of "screenings" at little, or no cost. The Wellness visit is the first step to getting involved with these screenings.
 
Don M. said:
That's right...the "wellness" visit/exam is an "opportunity" for a person to visit their PCP, and discuss any issues they may be concerned about...and then schedule any tests, etc., related to their concerns. Medicare, and most health insurance plans cover a number of "screenings" at little, or no cost. The Wellness visit is the first step to getting involved with these screenings.
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Exactly! We've both had our exams in the past and our PCP went over all medications, concerns, etc., and he did a prostate exam on my husband last year and that's when he found out it was enlarged. We're in the process of getting a new PCP and it's not easy because there just isn't quality doctor's where we live :(
 
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Colleen said:
Exactly! We've both had our exams and our PCP went over all medications, concerns, etc., and he did a prostate exam on my husband last year and that's when he found out it was enlarged. We're in the process of getting a new PCP and it's not easy because there just isn't quality doctor's where we live :(
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It's important to find a PCP that is interested in the patients health...rather than just "milking" Medicare. There have been numerous reports in recent years about doctors in areas with a high concentration of retirees, such as Florida and Arizona...who just offer minimal care/concern to the patients, and rush them through so as to maximize their Medicare payments. If a person feels they aren't getting the proper care, they should search for a better doctor, and in many cases, filing a Medicare Fraud report on the Medicare web-site, might well be in order.
 
Don M. said:
That's right...the "wellness" visit/exam is an "opportunity" for a person to visit their PCP, and discuss any issues they may be concerned about...and then schedule any tests, etc., related to their concerns. Medicare, and most health insurance plans cover a number of "screenings" at little, or no cost. The Wellness visit is the first step to getting involved with these screenings.
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I do all that at my annual checkup.
 
I just got a call a few weeks ago to sched this Wellness" through my MED. adv plan. So this nurse practitioner who I've never met before never knew me all before, wants to go all over my records, of which I have many for the last couple of years, tell me how I'm doing & what to do next, for about 45 min then the primary care doc will come in for about 5-10 minutes. If it's only a $5 copay I might go for the entertainment, but not if it's more. Rolling eyes here. This health plan tries something new every few yrs. a Their last thing was the "Nurse Navigator" who was supposed to guide people around the system, but turned out I knew more about programs $ services than she did.
 
Exactly! My appointment (which I did not keep) would have been with a total stranger. My doctor was not involved at all and he certainly wasn't at the Urgent Care where my exam was to be done! I wonder what would have been billed to my insurance and how much. I understand they can bill any amount they want and will only get paid by Medicare what's "reasonable and customary", but to bill for $309 in my husband's case, and not even get an exam, is a disgrace.
 
Don M. said:
If you are over 65, and on Medicare, an "annual" checkup, and an annual Medicare "wellness" visit are virtually the same.

https://www.caring.com/questions/what-is-the-difference-physical-and-medicare-wellness-exam
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I beg to differ. In my experience, they are nothing at all alike. Th so-called "wellness" thing is something set up by the insurance carrier (NOT Medicare) as an excuse to send a big fat bill to Medicare for sitting there and asking a bunch of questions about your medical history, which they already have. There is no physical part of the alleged wellness exam. It is a total ripoff and a waste of time.
 
Colleen said:
Exactly! My appointment (which I did not keep) would have been with a total stranger. My doctor was not involved at all and he certainly wasn't at the Urgent Care where my exam was to be done! I wonder what would have been billed to my insurance and how much. I understand they can bill any amount they want and will only get paid by Medicare what's "reasonable and customary", but to bill for $309 in my husband's case, and not even get an exam, is a disgrace.
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I agree. It's a ripoff, pure and simple.
 
rgp said:
Not my implication at all, My apologies if I have offended.

But let's be honest...quite often it is the case, and many of us live in denial of it. The doc is a professional , looking at it from the outside . And very possible he sees something you have not yet come to terms with.

If I may suggest?...explain your view to both of them, perhaps they didn't realize, and in the meantime be thankful you have a caring daughter.

Again, my apologies if I'm out of line.
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First off, it may be "often" the case, but more often it is not. Secondly, I am not in denial of anything. I live alone and take quite competent care of myself, so much so that the doctor let me go home on my own two days after my hip surgery, confident that I would do fine, and I did.

Secondly, the person I was speaking of was not the doctor, but a physical therapist visiting at my home. The other person involved was my daughter in law, there to visit. The therapist had no idea who she was, or whether I wanted my medical issues shared with her. The therapist just spoke to her over my head because she was a younger person. She could have been a census taker or my cleaning lady or any random person.

And yes, I shared my "view" with her, and then asked her to leave. I then called my surgeon and explained my "view" to him. He was horrified that the therapist had behaved that way and had, in fact, even breached my medical privilege by discussing my case with a, to her, random stranger. He apologized and told me he would not use that provider again.

I refuse to be treated as a mental defective or second class citizen simply because I am older. Older people are entitled to the same respect as any other patient, and should be dealt with directly just like any other patient until there is reason to believe they are not capable with dealing with their own affairs.
 
"I refuse to be treated as a mental defective or second class citizen simply because I am older. Older people are entitled to the same respect as any other patient, and should be dealt with directly just like any other patient until there is reason to believe they are not capable with dealing with their own affairs."........

I applaud you and agree 100%! It's our bodies and if we don't speak up for what we want or don't want done with it, then the blame is on us.

Ever since this "Wellness" exam debacle, we've been going to look for another doctor. It's not easy where we live to find a "quality" doctor so we've been dragging our feet on making a change. Well, today motivated us and tomorrow when we go into town, we're stopping in at a doctor's office to get a "feel" for the place. I've worked in many doctor's offices and hospital settings, so I'm a good judge of how things are run by looking at the front reception area. Hopefully, there will be good vibes.

What pushed us over the edge today was my Rx's. Last week I called my doctor's number but never got to talk to anyone to tell them I needed a refill on a couple Rx's. The phone just rings and then it has a message to leave a message and someone will get back to you. I gave up after a couple calls and submitted my Rx number to our pharmacy and asked them to contact the doctor. Today my husband had to go to town so he stopped at the pharmacy to pick up Rx's (he had one, too) and the pharmacist told him that the doctor's office has never gotten back with them to give me new Rx's. Our pharmacist was quite disgusted about it and said he would contact them again. When my husband paid for his RX he told the girl we were getting a different doctor, and she said, "That's probably a good idea." We don't know what's changed with our doctor, but something is going on. Time for us to move on.
 
This morning I went for my 1st Wellness appt at my primary doctor's office. I didn't see him,instead one of his PA's{physician assistant}. She was very nice, checking to see how I was feeling emotionally/physically. She took my blood pressure,ask me a couple of questions. I did ask her to ck how tall I was, because I have heard as one gets older, you begin to shrink. I was pleasantly surprised to know I'm still 5'11 inches tall.
I try to go see my doctor once a year,I have no problems by participating with this wellness appt. She did tell me I'll be getting a $20 Visa gift card in the mail Sue
 
skipdisk said:
Hi Everyone,

I just heard from a friend that Medicare is offering something called an "Annual Wellness Visit" (different from annual physical). During this visit, the doctor goes over your entire medical history, provides a long term medical plan and is free to patients! Seems quite good, almost too good. Curious if I should talk to my doctor about this.

Have you been through an annual wellness visit? How was it? Or if not, why not?


=========================================================

Yes we get one.

We have a Medicare Advantage plan with Blue Cross. We get one free physical each year.. a good one with blood work. BC also sends each of us a $25 gift certificate to a store of our choice.
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oldmontana said:
skipdisk said:
Hi Everyone,

I just heard from a friend that Medicare is offering something called an "Annual Wellness Visit" (different from annual physical). During this visit, the doctor goes over your entire medical history, provides a long term medical plan and is free to patients! Seems quite good, almost too good. Curious if I should talk to my doctor about this.

Have you been through an annual wellness visit? How was it? Or if not, why not?


=========================================================

Yes we get one.

We have a Medicare Advantage plan with Blue Cross. We get one free physical each year.. a good one with blood work. BC also sends each of us a $25 gift certificate to a store of our choice.
Click to expand...

An Medicare "annual wellness visit" is NOT an annual physical. It is a different thing altogether, and is basically a review of your medical history -- that's all.

The following is from the Medicare website:

SUBSEQUENT AWV COMPONENTS: APPLIES FOR ALL SUBSEQUENT AWV

s AFTER A
BENEFICIARY’S FIRST AWV
Acquire Updated Beneficiary Information
Action
Elements
Update HRA
●
Collect self-reported information from the beneficiary
You or the beneficiary can update the HRA before or during the AWV encounter; it
should take no more than 20 minutes
●
At a minimum, address the following topics:
Demographic data
Self-assessment of health status
Psychosocial risks
Behavioral risks
ADLs, including but not limited to: dressing, bathing, and walking
Instrumental ADLs, including but not limited to: shopping, housekeeping, managing
own medications, and handling finances
Update the list of current providers
and suppliers
Include current providers and suppliers regularly involved in providing medical care to
the beneficiary
Update the beneficiary’s
medical/family history
At a minimum, update and document the following:
●
Medical events of the beneficiary’s parents, siblings, and children, including diseases
that may be hereditary or place the beneficiary at increased risk
●
Past medical and surgical history, including experiences with illnesses, hospital stays,
operations, allergies, injuries, and treatments
●
Use of, or exposure to, medications and supplements, including calcium and vitamins
Page 7 of 17
MLN Educational Tool
The ABCs of the Annual Wellness Visit (AWV)
ICN 905706 April 2017
Begin Assessment
Action
Elements
Assess
Obtain the following measurements:
●
Weight (or waist circumference, if appropriate) and blood pressure
●
Other routine measurements as deemed appropriate based on medical and
family history
Detect any cognitive impairment
the beneficiary may have
Assess the beneficiary’s cognitive function by direct observation, with due consideration
of information obtained via beneficiary reports and concerns raised by family members,
friends, caretakers, or others
Counsel Beneficiary
Action
Elements
Update the written screening
schedule for the beneficiary
Base written screening schedule on:
●
Age-appropriate preventive services Medicare covers
●
Recommendations from the
USPSTF
and the
ACIP
●
The beneficiary’s HRA, health status and screening history, and age-appropriate
preventive services covered by Medicare
Update the list of risk factors and
conditions for which primary,
secondary, or tertiary interventions
are recommended or underway for
the beneficiary
Include the following:
●
Mental health conditions
●
Risk factors or conditions identified
●
Treatment options and their associated risks and benefits
Page 8 of 17


MLN Educational Tool
The ABCs of the Annual Wellness Visit (AWV)
ICN 905706 April 2017
Action
Elements
Furnish personalized health advice
to the beneficiary and a referral, as
appropriate, to health education or
preventive counseling services
or programs
Include referrals to educational and counseling services or programs aimed at:
●
Community-based lifestyle interventions to reduce health risks and promote self-
management and wellness, including:
Fall prevention
Nutrition
Physical activity
Tobacco-use cessation
Weight loss
Furnish,
at the discretion of the
beneficiary
, advance care
planning services
Include discussion about:
●
Future care decisions that may need to be made
●
How the beneficiary can let others know about care preferences
●
Explanation of advance directives, which may involve the completion of standard forms

I am sorry about the formatting. The form did not copy well from the website. ANYWAY, you can see that this is NOT an annual physical.
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My wellness visit, which was not free, but which I have to do if I want my prescriptions renewed, involved a LOT of talking. And questions like "Do you feel safe at home?" and "Any falls recently?" She checked my gait, and asked a jillion more goofy questions, including '"Have you started smoking?" Um... no. I get that it's a Medicare protocol, but hubby's doctor never asks him any of that stuff. And if one of us needs those questions, then it's him. Sigh.
 
Colleen said:
It's a waste of my time and just another way for doctor's to collect $$$$$ without having to do anything.
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Have you ever considered going to another doctor instead of complaining about your doctor/clinic?
 
oldmontana said:
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Have you ever considered going to another doctor instead of complaining about your doctor/clinic?
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That's a pretty rude comment! Have you read the whole thread?? FYI...we have changed doctor's....if that's any of your business!
 
My wellness visit was free.. I'm sitting in the waiting room with a 2 page paper to answer questions....Unbelievable.. It asked how much alcohol in a day I drink? (I hardly drink alcohol, except on a Holiday)
How many times in a year do you visit your Doctor....Am I depressed....Do you get angry most of the time...and on and on with stupid questions....

I finally get to go to the room for questioning....It was weird!!!!! A nurse or whatever she was, started asking me questions....and drawing pictures....I had to draw a dog....a hamburger, and some other
stuff that I was really annoyed with....So after many questions, she asked me what she asked me 3 min. ago....I told her and she said it was wrong...So I said to her, Oh, maybe that was 2 min. ago...
She got perturbed....I didn't care, this was ridiculous thinking Seniors are senile... She leaves....The Doctor came in the room...(I have been going to this lady Dr. for 40 years)...She asked why
I didn't answer the question that the nurse asked...I told her a thing or too, and she said she is obligated to ask these questions for Medicare....So I asked, Did I fail....She laughed!!! She said No....
As long as you were talking and not slurring your words.....WHAT!!!!!! Good thing I love my Doctor...She stayed with me for 10 min more, just talking about her husband who had passed away....
 

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