Member Services: 877-514-2442

(from CGHC member Brian L.)

I wanted to share my story about something that happened during my annual wellness visit, and encourage other members to watch out for themselves and unfair provider charges.

I scheduled my annual routine visit with a primary care doctor, which I understand from CGHC is supposed to be included at no additional cost to me in my health insurance policy. I didn’t have a regular doctor, so I checked CGHC’s provider directory and selected a general medicine physician, called his office and scheduled my appointment.

When I arrived for my appointment, the doctor’s office tried to charge me a copay. When I explained that I was there for an annual wellness visit which should be at no cost to me, they explained that I had to pay additional for a “new patient” exam. When I refused, the person at the front desk said that they would just put it on my bill.

I called CGHC’s member services department to let them know what happened. The person I talked to said that I should not be charged extra by the physician’s office, and that she would take it to her supervisors. I understand the supervisors are now working with the provider system to ask that CGHC members not be charged for a new patient visit over and above what the provider is charging to the plan for a wellness exam. I still don’t know what will show up on my bill.

When I told this story to a colleague, she told me she had a similar situation occur when she took her kids to the pediatrician for immunizations. Immunizations are also supposed to be covered at no cost, but the doctor’s office tried to charge her a copay because the children were weighed and measured. She paid the copay, but then made a point of talking to the doctor about it. She said that she would switch physicians if it wasn’t reversed. She also called the doctor’s billing office and filed a complaint. About 3 weeks later, they refunded her copay.

It is my opinion that health care is broken. But sometimes, we get mad at insurance companies when the issue is with health care providers. There is no reason a doctor should be charging us for something that our insurance co-op already pays for. I encourage my fellow members to stand up for themselves when a provider charge doesn’t seem right. This is how we can work together to change things.

So what should you do if your provider tries to charge you for a no-cost preventive service?

  1. Call Common Ground Health Care Cooperative’s Member Services department at 877.514.2442. We need to understand your story so we can work with our provider partners to protect our members. While we can’t control what providers bill for, we can work with the leadership of our provider system partners to get them to change what they do and how they treat our members. We will fight for what’s right on behalf of our members.
  2. Complain to the billing department and your doctor. Just like our member Brian explained in his story, his work colleague got action because she complained to her doctor and the physician’s billing office. The doctor may say they have nothing to do with the billing, but doctors should be held accountable for their billing practices. Your voice is more powerful than you may think.
  3. Complain to your legislator or the Wisconsin Department of Health Services. It is the law of the land that individuals should be able to get preventive services at no additional cost. If you feel your doctor’s office is not abiding by the law, you may wish to contact either your lawmaker or the Department of Health Services. More information is available at dhs.wisconsin.gov/guide/probmddds.htm 
  4. Know the facts. Understand what is and is not covered during a no-cost preventive care visit. Preventive care visits cover a routine checkup, certain immunizations and certain screenings that are appropriate to your age. But if you bring up something that is bothering you and the doctor looks into it, the visit will rightfully turn into a diagnostic visit that you could rightfully be charged for.

Click here to learn more about preventive services through your CGHC plan.

Member to Member is a feature in our blog and newsletter where real members talk about lessons learned while navigating the healthcare system. If you have a story you’d like to share with other CGHC members, please reach out to us at:MemberStories@cgcares.org

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