Dr. Roach: Wellness visits don't double as regular checkups

Keith Roach
To Your Health

Dear Dr. Roach: Our excellent insurance allows for a yearly wellness visit at no cost. My regular copay is a very reasonable $10. So, the cost is not the real issue. For the past few years, after my visit, I have received a bill for $10, with the explanation that while the wellness visit was free, I was being charged for a regular visit also. This because we discussed my blood pressure, which is a preexisting condition. It seems that should be part of my wellness discussion. 

The billing office says Medicare Advantage programs allow for this (double?) billing, based on how the doctor codes the exam. Interestingly, my wife, who sees another doctor in the same practice, has never been billed in this manner, even though her doctor has discussed preexisting conditions. 

I have a good relationship with my doctor, but have not discussed this with him to any real degree. I guess that I don’t want to rock the boat. But this just seems wrong. Or, if it is permissible, then it seems like a contributor to runaway health costs. I’ve used the word unethical with the billing staff and supervisor. They say it’s not. Am I overreacting?

— Anon. 

Dear Anon.: The annual wellness exam is intended to allow you and your doctor time to discuss strategies for keeping you healthy. It may include performing or scheduling screening tests, discussing physical activity and diet, and other interventions to help reduce injury and disease. The annual wellness exam is NOT a regular visit to discuss problems and do a physical exam.

Some physicians will, in addition to the wellness visit, also do a brief regular visit, such as monitoring and discussing blood pressure. In that case, an additional charge for a “problem-based visit” is allowed. It is neither illegal nor unethical to bill the insurance for both types of services if both are provided. That’s what your physician has done, assuming he did the wellness visit appropriately. However, discussion with my colleagues has shown me that many will NOT bill the insurance for the problem-based part of the visit, as many of their patients don’t understand this issue and the doctors don’t want to upset their patients. It sounds like your wife’s doctor is in that camp. 

People without your excellent insurance have to pay a much larger fee, and I can understand why they might be upset, as the nature of the annual wellness visit is often not well explained. 

Dear Dr. Roach: Several different religions use a single cup during communion that is shared by the members of the congregation. The cup is just lightly wiped off between each person’s communion. Isn’t this an almost certain way to spread germs, especially during the cold and flu season?

— S.J. 

Dear S.J.: The available data suggest that the risk of acquiring infection from a shared communion cup is very low. Wiping a silver chalice with a linen cloth reduced the bacterial count on the cup between each person by 90%. Viral infections are more likely to be spread via respiratory droplets from sitting next to someone than by sharing a communion dish. 

Current restrictions put in place specifically to slow the spread of coronavirus have effectively suspended church services in most countries. Many are live-streaming their Masses, and the Catholic Church, for one, has encouraged “spiritual Communion” until a return to safe in-person service is possible. 

Readers may email questions to ToYourGoodHealth@med.cornell.edu.