Guest columnist Marietta Pritchard: Beware, Medicare ‘wellness visit’ no longer a medical exam


Published: 03-31-2023 8:25 PM

Last July, I visited our new doctor for what I thought was an annual checkup. I brought with me an annoying problem I’d been having, and he made a referral for me to see a specialist, who has taken care of the problem. After that July visit — a pleasant conversation with a physician I have come to appreciate — I received a bill for $320 that I thought was an error.

Surely that bill doesn’t compare with the kinds of crushing medical bills that some Americans have gotten over the past years. I have read about people being charge thousands of dollars for brief visits to the emergency room, astronomical bills for uncomplicated surgeries. But this one happened to me and it has taught me something about the state of our medical care.

Now, I have been a Medicare recipient since 2001 and I am not used to getting bills for much or any of my health care. Needless to say, I have been both lucky and relatively healthy. So I called the number on the bill, Mass General Brigham, who now are partnered with Cooley Dickinson, with which our health care group is affiliated. (Already, the layers of who’s on first are somewhat dizzying.)

They explained that Medicare had denied the claim, but that they’d give me a discount of $78.50 — bill now at $235.50. I have no idea why that discount was given, but never mind, I’ll take what I can get.

Still, I wanted to know why I had been billed at all for what I thought was an annual physical, always fully covered in the past. Silly me. After several months of getting this bill and contacting various offices in the hierarchy, including, eventually, Medicare, I learned that what I’d had was a “Wellness Visit,” and that Medicare pays for those, but only as Medicare describes that visit.

Let me quote from the Medicare site. The purpose of the Wellness Visit is to “develop or update your personalized plan to help prevent disease or disability, based on your curent health and risk factors.” Then follows a sentence in boldface: The yearly “Wellness” visit isn’t a physical exam.

Translation: If you bring up any problems — what are referred to as “additional tests or services” — the insurance will not cover them. In my case, the “additional” service provided was presumably a conversation and a referral.

II finally talked to the helpful office manager of the medical group our doctor is part of. She agreed that the stipulations made no sense and that they were certainly hard to understand. Presumably, she explained, if I had made a separate appointment to see the doctor to talk about my problem, it would have been covered. Go figure.

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I will pay the bill for this Wellness Visit that just happened to include a conversation about a medical problem. But buyer be warned. Check to make sure what kind of a “visit” you’re having with your doctor: The Wellness Visit is a highly restricted event. Do not dare to bring up anything that’s bothering you.

I am angered at this perversion of medical care, but as a writer who tries to pay attention to how words are used, I am almost equally offended by this nonsensical designation. Wellness, indeed! As opposed to what? A sickness visit? What did we use to call these interactions? A conversation with the doctor?

And where is single-payer health care when we need it?

Marietta Pritchard lives in Amherst.