Quote:
Originally Posted by PilotMan
My wife scheduled a well check to get her regular scrips renewed, got blood work done, etc....typically well checks are covered expenses. We got a bill for the copay. When she called to complain and ask why, it's because, she was told, that the doctor prescribed her 'new' medication and therefore it counts as a sick visit. This new medication was a script for vitamins. She called it out as bs, and the answer was, 'this is just how it is.' So, if you go see a doctor and you're well, IF they find something they don't like it's a sick visit. Coincidentally, if she had waited until after the appointment to do her blood work (she did hers so it was done and could be reviewed during the visit) the doctor could have just sent out a script after reviewing it and there's no way she would have been charged for that.
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It is going to depend on how your Doctor coded the claim, meaning the primary DX. If it is a well visit the primary DX code should reflect this, as well as the CPT for the consult. Check with your doctor on that and if they coded it as a well visit submit an OIG complaint. It the doctor coded it as a sick visit they can submit a corrected claim.