A New Medicare Surprise

I had a column all written and ready to publish for this week. Then we picked up our mail the other day and I got a statement from Medicare for my wife’s latest visit to her doctor.

Everything changed…

Included in the Medicare Summary Statement was a charge of $160 for something coded PPPS, Initial visit (G0438). Of that amount charged, Medicare paid $156.30, but the good news was that the column labeled, “You May Be Billed” showed a zero balance.
Since the $160 charge was in addition to the Office/outpatient visit of $125, I decided to investigate and learn what the above charge covered.

I went to my Medicare & You 2011 booklet to decode the esoteric charge code. Sure enough, on page 39 there was reference to a “Wellness Exam” for which Medicare patients are eligible once a year. It was further defined as a personalized prevention plan screening. In case you hadn’t noticed, the acronym for that long definition is PPPS.

So, the next question to be answered was, “What exactly is a personalized prevention plan screening?” To have a cost of $160 – more by far than the office visit itself – it must consist of several tests and some blood work and such.

Well, no, it actually consists of a nurse asking you several seemingly innocuous questions. Questions like, “Do you ever feel depressed or helpless?” and “Is there any abuse in your home?” and “What day is today?” Then there are some repetitive tests where the nurse names three animals and then asks you to repeat those names several minutes later.

My wife informed me that the screening lasted several minutes and some of the questions were silly while others were highly inflammatory and personally embarrassing. She was reluctant to even answer some of them.

Okay, now you know what PPPS, Initial visit (G0438) means, and what it costs Medicare. What you don’t yet know, but you will now, is that this test is approved by Medicare for annual repetition. Those same questions will be asked every year and the doctor will charge Medicare (maybe, if the charge doesn’t get inflated) $160 for it and will get paid (maybe, if Medicare doesn’t reduce payments) $156.30.

I read an article today that stated that our current United States population contains slightly over 35 million people over the age of 65. Just for the heck of it, I multiplied 35 million times $156.30 to see what the total cost of those annual screenings would be.

Are you ready for this? $5,470,500,000 is the total, but if you would rather I state it longhand it is 5 billion, 470 million, 500 thousand dollars PER YEAR.

And just to further factor in the increase in the elderly population, which was estimated to be 71 million by 2030, that number will be over 11 billion dollars. That is not for any kind of treatment at all, but merely for asking a series of questions and posing some memory skill tests.

If this doesn’t make you the tiniest bit upset, you must be one of those young kids who wish that us old folks would hurry up and die. And if it does make your blood boil like it did mine then I have more bad news for you.

You ain’t seen nothin’ yet!