So much for the no-copay physical

July 20, 2012

My younger son went for his annual physical in May and I checked with our health plan at that time to confirm that no co-pay is billed for such a visit.

Today I got a call from the billing department that we owe a copay for that visit.  I talked to a great many lovely people about why this comes to be and have left messages that maybe people want to rethink how all these systems intersect, because apparently the net result is that this “benefit” we were told we have, in practice we really don’t.

What happened is that the doctor discussed and wrote a prescription for a medical problem during the visit.  That resulted in his billing the visit as both a physical and a sick visit.  It didn’t matter that the visit had been scheduled as a physical and it was the doctor who brought up the medical issue, I think from results from blood work done long before in connection with a different visit about a different issue.  (We might also wonder why the doctor didn’t get back to us about the blood test results by phone at some earlier point between the testing and the independently scheduled physical.  At least in this case, no fatal disease is involved; in Willy’s case, I’m pretty sure the same pattern of tests and visits occurred, but the disease involved was a fatal one.)

I suppose if we count it as two separate visits temporally combined, one with a copay and one without, it wouldn’t rankle, but from my point of view, this basically eviscerates the no-copay physical insurance benefit.  If it’s the case that if doctor and patient actually discuss a medical issue during the visit it turns into a sick visit with a co-pay, what is the no-copay physical benefit really?  It’s saying that if you have no medical issue and are healthy, you get a bonus, in a sense, it doesn’t actually encourage people with medical issues to go for early treatment.

Oh, capitalism — it finds a way to make a buck and redistribute money (here, the co-payment amount) despite other people’s best efforts at implementing a different policy and trying to produce different behavior (encouraging people to get physicals to reach medical conditions earlier).

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