Uh, About That “Free” Annual Exam Under Obamacare…

…as it turns out, it may not be all that free – especially if you actually have something wrong with you. Dr. Peter Weiss writes:

Obama won, Obamacare is the law, and, as my wife says, I will just have to learn to dance to a new song.

Now, don’t get me wrong, Obamacare is awful. Forget all the “free stuff” it provides. Children covered on their parents’ plan until 26 years of age? A scam, making young adults — excuse me, children — pay for complete, comprehensive health insurance when all they need and should pay for is major catastrophe insurance. Then there is the “annual ” or “preventative” exam, which according to Obamacare is “free.”

You gotta love this stuff. I wish I had the chutzpah of the people who wrote Obamacare. What they did not tell you, and I am, is that it covers absolutely nothing more than the bare minimum.

I have now posted a notice in my office and each exam room stating exactly what Obamacare will cover for those yearly visits. Remember Obama promised this as a free exam — no co-pay, no deductible, no charge. That’s fine and dandy if you are healthy and have no complaints. However, we are obligated by law to code specifically for the reason of the visit. An annual exam is one specific code; you can not mix this with another code, say, for rectal bleeding. This annual visit covers the exam and “discussion about the status of previously diagnosed stable conditions.” That’s the exact wording under that code — insurance will not cover any new ailment under that code.

If you are here for that annual exam, you will not be covered if you want to discuss any new ailment or unstable condition. I cannot bait and switch to another code — that’s illegal. We, the physicians, are audited all the time and can lose our license for insurance fraud.

You, the patient, will then have to make a decision.

Do you want your “free” yearly exam, or do you want to pay for a visit which is coded for a particular, new problem? You can have my “free” exam if you only discuss what Obamacare wants me to discuss.

This happened to me personally, as a patient, when I went for my physical. It is the law. If you are complaining of a new problem, then you have to reschedule, since Obamacare is very clear as to what is covered and what is not. Obamacare — intentionally — makes it as difficult to be seen and taken care of as possible.

Patients can be very tricky. I have had patients make an “annual” exam, only to want to discuss and be treated for another ailment. I can’t do it.

But it is “free” right?


21 thoughts on “Uh, About That “Free” Annual Exam Under Obamacare…

  1. Saw this article this morning. This is an excerpt from the article. Maybe one of you guys will read and give me your opinon on what it says.

    Laws don’t curb pricey prostate cancer treatments

    NEW YORK (Reuters Health) – Laws meant to prevent the overuse of expensive healthcare services don’t stop doctors from using pricey prostate cancer treatments, according to two new studies.
    Researchers found doctors used robots and special radiation to treat prostate cancer regardless of whether their area had laws requiring government approval before money is spent on healthcare facilities and new equipment.
    “Certificate of need laws were designed to align public need with use of different services,” said Dr. Bruce Jacobs, a lead author of one of the studies from the University of Michigan in Ann Arbor.
    The U.S. government required states to implement the laws in the 1970s and early 1980s, but stopped a few decades ago. Still, some states continue to use the laws in an effort to control costs.

    Sorry – my bad. I forgot to provide the link to the article!! 😦


    • I think it illustrates pretty well two things that we have been saying about Obamacare – 1) it does nothing to truly reduce costs and since it doesn’t and it is mandated, 2) there is no incentive for the individual to worry about the costs.

      These two things guarantee that costs will go up, the government will deem them unaffordable and either ration care by restricting what you can have done or bust the bank to pay for it.

  2. Does anyone else find it funny that the same people touting how great Obamacare is are generally (not always, but usually) the same folks who advocate kicking God out of the public arena in favor of “science?” Now that is not what I find funny. What I find funny is that these same “science worshipers” are the ones who think they can violate the laws of physics by giving away “free stuff.” I mean, didn’t their “”science god” teach them that the reason there is and will never be a perpetual motion machine is because there is no “free” energy in this world?

    Ooops, sorry, I forgot: the same idiots who believe in free healthcare are also still searching for their holy grail of free energy. My bad, never mind. Go back to your regularly scheduled programs.

    • FREE energy ….
      like perpetual motion….

      Never mind SOMEONE, somewhere, had to MAKE, ie. WORK, to provide ANY good or service.

      Then government CONFISCATES the good or service, and tells the “haters” & “envy-ers”, “here is some FREE stuff” for you.

      • Hello Texas 95, Not on topic, but since your name is Texas I thought u might actually live in TX. I need a realtor in the Dallas-Fort Worth area and I was wondering if u might know one. Thanks!

  3. Sorry- but as someone whose wife is a doctor- and who has many friends/family who are- I call BS.

    first off- Free what? We are all required to BUY health insurance. From private, for profit companies. So what is this “free stuff” he rambles about? Oh- you mean we actually expect a service for the money we pay- how dare we.

    Second- only “Catastrophic insurance” for those under 26? What sort of moron is this? Does he have any concept of the rate of sickness among children? Not to mention childhood cancers. Autism spectrum disorders. Lyme disease. Obesity. Diabetes. (I really, really, should not need to be correcting a supposed “doctor” (the onlyone I can find matching that name is in- wait for it- Beverly Hills).

    He’s also FOS about the “yearly exam” and the coding. And never mind that this is, the underlying issues of coding, an ISURANCE issue- not obamacare.

    Sorry- but this guy is either a) not a licensed doctor, and/or b) a partisan hack willing to lie.

    • But drug boy, isn’t Obamacare “insurance?” Then again, the SCOTUS deemed it a tax. The not-so-funny irony about Obamacare (true story) is that a liberal friend of mine discouraged me from starting a business due to Obamacare. 😯

    • “Sorry- but as someone whose wife is a doctor- and who has many friends/family who are- I call BS.”

      My isn’t that trite? Well, for a man who is married to a physician, you certainly have some facts mixed up. It’s unfortunate that she did not keep you from falling in to this little hole you have dug for yourself. But since she has, let’s just discuss a couple, shall we?

      “first off- Free what? We are all required to BUY health insurance. From private, for profit companies. So what is this “free stuff” he rambles about?”

      He “rambles” about this exemption specifically …

      From page 128-129 of the entitled The Patient Protection and Affordable Care Act:

      ‘‘(e) EXEMPTIONS.—No penalty shall be imposed under subsection
      (a) with respect to—

      It also should be noted that there are quite a few other exemptions as well (i.e, American Indians, Incarcerated Individuals, Clergy, and many more) who will never be required to purchase insurance under the The Patient Protection and Affordable Care Act. The government will simply just cover them, and no charge.

      “Oh- you mean we actually expect a service for the money we pay- how dare we.” &
      “Sorry- but this guy is either a) not a licensed doctor, and/or b) a partisan hack willing to lie”

      The man is actually spot on, and again, if you actually spoke to your wife on occasion, she could have prevented you from making such a grievous misrepresentation, but since you have, let’s go right on ahead and debunk your assine assertion, shall we?

      There is one billing code for yearly checkups (G0438 Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit.). It’s the only code we can bill for, and there is a required list of questions that have to be documented in order to receive payment for that visit. Any additional services outside of the scope of that code are non billable. You suggest we should work for free? Do you?

      This exam includes a PPS exam for initial screenings, but makes no previsions for new complaints or subsequent work ups DDx. Now should you like, I can list the details of what you will get during this “Annual Wellness” visit, which by the way only pays 4.74 Relative Value Units (not very much considering the amount of time it will require to ask all of the required questions – $159.25)

      Any further fallacies, or misunderstandings you would like to clear up tonight drugsandotherthings?

      • My sister just got back to me, and she had this to say:

        My thoughts? He’s right: like it or lump it, we are all going to have to adjust. Physicians especially are hating this new plan, as it will hit their wallets pretty hard. I already know of three in town that are refusing new Medicare patients as of Jan. 1.
        Too early to tell, but I anticipate the system will mimic Ireland’s: no ins= long waits/ shitty service. People with ins= shorter wait and same shitty conditions. Either way, it’s a lose/lose system. And I hope I stand corrected.

        • “He’s right”

          He = who? And, is your sister in healthcare? Sounds like she is. The program appears to offer a model like the UK, but will likely trend closer to the Canadian system once large employers dump the more costly private plans.

          There will need to be rationing and then we’ll begin to see the domino effect from that.

          • I e-mailed my sister the article from Dr. Weiss. I just noticed that she had sent this follow-up:

            PS……. And I have to call a little BS on this doc’s article.
            I’ve noticed, for example, that my ins. dictates that i will have to pay a higher co-pay for “specialists”; meaning the doc will charge a higher rate if he is not my primary. Ha!! Every doc I’ve seen has charged me higher rates, as they have ALL considered themselves specialists.
            In other words, regardless of Obama’s new plan, we can be assured that many physicians will find loopholes like this doc.

            Oh, and yes, that silly twin works at the hospital.

            • In an earlier article, I gave examples how physicians get paid (minus the adjustments for demographics). Generally a “specialist” (i.e., Cardiologist, Neurologist, etc) do get paid at a higher rate than do PCPs who are not specialized. I have not seen any documentation to suggest that will change under Obamacare, though with this law, and it’s some 18,000 pages of regulations to follow … anything is possible.

              But the current topic sticks to Primary Care, so let’s keep it right there. We’ve already discussed the 2012 Physician Survey that notes that nearly 60% of all PCPs are planning to retire over the next 4 years citing Obamacare as a reason for this early retirement. Others are closing shop and beginning to accept positions in their local hospitals. Others are circling their wagons to form super groups to share costs. And yet others are forming “Medical Clubs” were the patient pays a certain amount (I have seen a rage of $1600 – $3200/year) for the privilege of calling that person their MD. Others are simply no longer accepting Medcare/Medicaid patients in an ever growing number.

              Your sister is right though, physicians can charge co-pays … as long as those co-pays are consistent for all Medicare/Medicaid patients. Someone is going to have to make the payment, and it sure the hell isn’t going to be the Federal Government.

              As stated … there is no such thing as “Free”, and no one can expect a man or woman to work for free.

        • I had a friend who was involved in an auto accident in ireland, and he had nothing but praise for his care. jes’ sayin’.
          As far as crappy service, I get that here. If i get in and out of the doctor’s office, any doctor, in less than an hour, I feel blessed. If I actually see a doctor, and not an N-P, I pinch myself.

          • Greg, hate to say it buddy, but if Obamacare presses on “as is”, and the 60% of physicians who state they will retire in fact do …. you are going to be really whining about wait times, and Nurse Practitioners.

            The good news … you won’t be pinching yourself as much (damn, getting pinched hurts).

            • And what are they going to do instead, lay brick?
              The only insurance I could get was so bad, it only knocked 3k off a 35k bill. I got another 17 thousand knocked off on my own, by dealing with Sacred Heart directly.There’s fat in them thar bills.

              • “And what are they going to do instead, lay brick?”

                Well one example: One of your local physicians was smart enough to save money, and invest in rental properties, Greg. He’s now “retired”, and can be found coaching football at one of your local high schools (he was a quarterback for LSU at one point in his life).

                You see Greg, I know austerity is difficult for you to imagine, but physicians generally (not all of course) prepare for a life outside of medicine, just has this one has done. Truth be told, if more people practiced a bit of austerity in their lives, they could write their own dream retirements fairly easy … regardless of their hourly income. It’s not a novelty notion, it’s just sad that folks do not even have the imagination, or will power to look past their next round of bills, or that fancy car sitting on the car lot. They just want what they want, and want it now.

                Of course there is fat in “them thar bills”, and that goes back to a conversation I have had with you, McPherson, and several other of your liberal buddies, sadly, all you folks could offer was flippant retorts instead of just trying to understand the information I was offering. That’s what your partisanship gets you.

                As I have said on numerous occasions;

                “We have not seriously addressed tort reform, which other than the crazy insurance companies, is another top cause of overpricing…defensive medicine. The politicians never will though, they’re all attorneys.

                Pre-existing clauses need to go, but as part of a different overhaul. The program appears to offer a model like the UK, but will likely trend closer to the Canadian system once large employers dump the more costly private plans.

                There will need to be rationing and then we’ll begin to see the domino effect from that.

                I do not think the USPS runs anywhere as well as UPS or FedEx and IMHO, I believe the same will be said of government-run healthcare.

                I’m not commenting to change your mind, but allow others of us in the field the courtesy of having a differing opinion. We will all find out soon enough and I hope that it won’t be at the expense of what was once considered the best health care in the world.”

                Obamacare never was, and remains not the answer you people were looking for. And if you think it’s been bad the past 4 decades, you just wait for it moving “forward” …

  4. here is my question, obamacare offered me “silver coverage” for $260 a month. this gave me a $5000 deductable. That is $3120 a year. I make an average of 35000 a year. That makes my obamacare payment 8.5% of my income. More than my tax liability. more than my utility bills. more than my lot rent. I got pneumonia a few years ago, costing me $4600 to get a CT scan, a script for antibiotics, and rude treatment because I was uninsured.( the first two doctors i saw that day told me i had cancer) My “silver coverage would pay zero on such a visit, leaving me the $4600, plus the $3120 a year. Someone explain to me why any carpenter of my income level with a calculator would bother buying this crap. If a physitian cant charge obamacare that is being payed for by the customer for a checkup/screening once a year, don’t get mad at the disgruntled customer screaming “i cant work for free” and help us make some noise and get ur money out of the workingmans 8.5%

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