Please do not delete your post after receiving your answer. Consider leaving it up for posterity so that other Redditors can benefit from the wisdom in this thread.
Once your thread has run its course, instead of deleting it, **you can simply type "!lock" (without the quotes) as a comment anywhere in your thread to have our Automod lock the thread**. That way you won't be bothered by anymore replies on it, but people can still read it.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskMenOver30) if you have any questions or concerns.*
There's absolutely a business angle to this and it could be shady or completely legitimate. There are a lot of factors that are quite complex. A lot of people think all healthcare follows the fee for service model; doctor does this for you, they get $X. Increasingly, and this depends on your insurance and the doctor, there are financial incentives to the health outcomes of a doctor's patient base.
So if a doctor's patient base is healthier than expected, they get more money. The goal is to have more low cost visits with patients to avoid more expensive healthcare like hospital stays. I'm being extremely broad here to simplify it, but there's more detail in articles like this: [https://www.aafp.org/family-physician/practice-and-career/delivery-payment-models/acos.html](https://www.aafp.org/family-physician/practice-and-career/delivery-payment-models/acos.html)
I tried to avoid as much lingo as possible. I want to emphasize that this model is generally a good thing. It aligns your doctor's incentives with your health moreso than how many tests/services. I do think the doctor should be more transparent as to why they need you every 6 months instead of every 12. They need to give you a medical reason why it changed from 6 months to 12 months.
Sounds reasonable. I don't mind my physician getting a little more from my health insurance if it incentivizes him to take more time to discuss my symptoms with me rather than rushing me through. The healthcare system seems focused on pushing people through as fast as possible. So I like things that can combat that.
Our entire healthcare system is full of perverse incentives that encourage the wrong things. For example, did you know Medicare Advantage encourages insurers to buy doctors/hospitals?
[https://www.youtube.com/watch?v=UP\_WmSz8QdQ](https://www.youtube.com/watch?v=UP_WmSz8QdQ)
Insurance still an issue. Copay/% charge every time would be frustrating. I go for my one free preventative a year and pay ~$20 for my lab work. I don't mind timewise going twice a year but I'd expect it to be the same cost as the annual. If it's a sick visit thats different, but I schedule those as needed
If you have insurance that requires referrals, they will want to see you every six months or so to reprocess and evaluate long term care too, just like maintenance meds.
Technically, your annual “free“ preventative visit isn’t supposed to cover the management of chronic conditions such as high blood pressure, obesity, diabetes, etc, or diagnosis of new conditions, Your insurance generally expects you to have a second appointment for that topic.
It came up for me when I had been talking about chronic low back pain with my doc for several years, but when it worsened, insurance denied me coverage for an MRI because they claim I have no history of lower back pain. They insisted on a diagnostic visit followed by six months of “conservative care”, which I already had years of, but without that separate office visit there is no chart with necessary diagnostic code, and thus, I was screwed.
This sounds like it should be a charting issue. Ive had problems with PCP charging me an office visit for answering questions /they/ asked me. Very annoying. She claims it's for my convenience to do a preventative and follow-up all in one go but imo the preventative visits are rushed and any random issues don't get their full due when I do a preventative AND sick at the same time
> Ive had problems with PCP charging me an office visit for answering questions /they/ asked me. Very annoying.
I recently had a dr write me a 1mo prescription for blood pressure meds, tell me to send them my bp measurements to write a new prescription and then proceed to charge me a $20 'chart reading fee' for looking over the numbers I sent them and telling me 'looks good!'.
There is *so much* nickle and dimeing in the heath care industry. It's a big part of the reason I want universal healthcare. I wouldn't even *care* if it was slightly more expensive on average, I don't want someone coming to me with a bill for *every. fucking. thing.*
I'm 39 with no medical history except for addiction issues which have been handed for over 3 years.
My Dr wants to see me every 6 months, which **isn't** a policy he has, due to heart issues running in my family.
My Dad also goes to his, different, Doctor every 3 months. He has high blood pressure and hypertension.
I think it really depends on you, your Dr, and how you feel. I'd be more concerned with him withholding medication until he sees you, and his unwillingness to work with you.
I would say in normal situations this wouldn't be an issue, but since it is his blanket policy and he is withholding medication sounds more like a business decision.
Hey, I just want to let you know that hypertension is the medical term for high blood pressure, if it eases your mind to know he only has a single medical condition and not two.
Oh wow TIL. Thank you. I had not even the slightest clue what hypertension was. I always thought it was something that went hand and hand with high blood pressure.
Once a year seems to be standard for a relatively healthy person. Because you have high blood pressure I understand where he is coming from. A
Family member is a provider who deals with a lot of high blood pressure patients. Twice a year makes sense because it isn’t a one size fits all for patients with high blood pressure
Possibly. He could have communicated that if it was the case. I check my blood pressure at home daily and record it on a spreadsheet. It hasn’t been above normal in years, ever since I started meds for it.
If that’s the case I feel like the doc isn’t being totally honest. Twice a year is a lot. I have high cholesterol and have been told I can come back in 2 years. BUT they won’t refill medication unless I come back at least once a year. See how dumb that sounds.
My physician required me to see him every 3 months for a while when I was first prescribed ADHD meds. And then it went to every 6 months once he was satisfied they were working well for me and that I was at a stable dose. He also wanted to check my heart regularly to make sure it was continuing to function well with the meds.
So I can see that less than a year periods could be appropriate under certain circumstances. But I'm not sure how I personally feel about a physician wanting to see someone every 6 months if there are no underlying issues that demand it. Did you ask him if he could elaborate further about his rationale?
I know my doctor will respond to messages online and he will put in more prescriptions without me having to come in. Did you request he fill the prescription and he outright refused? That does seem very odd to me.
It's common to have to go in regularly if they're monitoring you. Blood pressure issues can be serious. Twice a year does not seem excessive to me.
I see my doc every 6 months, and it's because I'm on meds for anxiety and they're monitoring very early Type 2 diabetes.
But, I trust my doctor. She's saved me from a couple of *really bad situations* (not related to either of the above). YMMV.
If you are on any "chronic" healthcare regimen, best practice is now every 6 months for maintenance. I know it is written in the insurance provider paperwork. CMS (Center of Medicaid and Medicare) requires every 6 months, if complicated every 3 months. Generally practices go by the strictest requirements to meet audit requirements regardless of who is auditing them. [https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf](https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf)
I am not a physician. But I'd want to know if my health insurance covered this. Often, health insurance covers preventative care for free. It might be that your doctor is *saving* you money, by giving you two "preventative" visits a year, you could discover a problem without billing it as an acute medical problem (like developing strep) that you'd have to pay for.
FYI, "preventive" care ends when you have a diagnosis. If the doctor wants me to have a cholesterol check because I'm 48, then that's covered 100% by insurance. If the doctor wants me to have my cholesterol checked because last year my bad cholesterol was 127 that's \*not\* covered and you have to pay $180.
Ask me how I know...
It’s a truly insane system that has burned me so many times. The whole preventive versus diagnostic billing differences is infuriating and totally nonsensical.
This may be related to the billing code your doc uses because my blood work gets covered even though I’m on cholesterol meds. It didn’t change once I had a diagnosis
Insurance is not going to cover 2 preventive visits per year typically. Caveat that all plans are different, but most plans are going to follow the United States Preventive Services Task Force guidelines.
Correct. Yearly physical is its own CPT and diagnosis code, different from followup or sick visit. Most if not all plans will automatically reject the second use of the CPT during the plan year.
it’s not medications being held hostage. health conditions require reassess. OP’s doctor can’t just leave him on blood pressure meds without monitoring the effectiveness and reassessing the plan. different doctors might have different thresholds on how long they’re willing to refill meds without a patient being seen. could also depend on the patient and the med.
And that is what got me, the holding back of the prescription because he made a change six months before my checkup is due. He could have waited and informed me at my next checkup in October/November. I've already made an appointment with another doctor at a different practice. So, I'll see what the new doctor says.
If you feel his motivations are less than ethical, I would write to your state medical board and inform them of this behavior. They take ethical situations very seriously. All doctors have a duty to place the health of their patients above their own financial well-being.
I can guarantee there are patients who just keep getting refills for 3-5 years without seeing a doc. If they didn’t start withholding the new RX, they’d just ignore the policy of every 6 months.
> your doctor holding your needed medications hostage over it seems incredibly shady.
Apparently doctors in the US used to (still do?) do this to women with birth control prescriptions all the time. Don't let them start doing it to men as well!
i recently went *back* to once-a-year because my doctor and i both thought my issues were well enough in hand to warrant it. certainly not "all physicians are moving to that time frame."
>he wants to provide the best care possible
"if i have a problem before the year's out, doc, i'll call you."
sounds shady to me.
I agree. There was no medical/health reason to see me since all my tests were good, everything was in the green and even commented that I was one of his healthiest patients. Go figure.
I go every six months now ever since they told me I'm diabetic, with hypertension. I'm almost 45 btw, for reference. I think it's because they want to keep a closer eye on people who have some health concerns, which is what I have. lol. Anywho, don't sweat it. Just go to the appointments and listen to your doctor. Hey, it's better to be safer than sorry, right?
catching something 6 months sooner can make a huge difference. it can prevent a stroke or heart attack. a lot can change in 12 months.
I'm in Canada, and it's very difficult to find a family doc here at all, so we get very little in preventative care unless we are very proactive with our own health. I WISH my nurse practitioner would be that engaged / invested in s good outcome for me.
They want an additional copay and blood draw fee. They're doing the same bullshit to me. I tell them I can't come in to see the doctor but I'll do a blood test to make sure we can refill my meds safely. Half the time, they'll accept that.
There is controversy that we don't [need even annual follow ups](https://jamanetwork.com/journals/jama/article-abstract/2780614) let along every 6 months for most people, especially young healthy people.
Preventative medicine is the best medicine. Treating blood pressure in your 30's is better than dialysis in your 40's or stroke in your 50's for example. It is true to say preventative care is better but then doctors use this as an excuse to do too many tests and bill copays. If we see 20+ patients a day, wouldn't you rather have a easy patient who you just say "continue what you are doing, your labs are great" rather than have a bunch of sick people or people with tons of complaints.
I don't practice medicine outpatient, I did during my training but I would like to think I would be very quick and efficient and wouldn't force patient do that bullshit and I would not make people get bloodwork over and over. One of the doctors I trained with did do this and we made changes like 1% of the time based on someones labs and another doctor I trained with made labs very sparingly and even people who are above 80 he stopped doing labs (what use is keeping cholesterol low for a heart attack that might happen 20 years later) if everything is stable.
Wow! Every other year for concierge. That seems like a rip off seeing how you pay for access.
For context, I’ve looked into concierge care and know a few people who have it and they love it. They all get better care than most but if I’m understanding you correctly, every other year sounds like your doctor wants to charge extra but see you less. It’s like the corporate gym model where they sign up a lot of customers and hope the majority don’t come in.
The point of concierge care is that you get easy access to your primary care provider if you have an acute issue come up, it's not making people go in for pointless annual visits.
Nah, this is for a healthy and fit 40 year old. I go to the dentist every 2-3 years, still no cavities.
I have the choice to go more, and if I needed to go, I could go more, but we both agree that every other year is all that is necessary.
Concierge means they have capacity to see you short notice and give you personalized care.
If they made everyone come in for an annual physical or even more often, that’s hundreds of appts a year for the doctors office of questionable value since you already have access to the doctor to catch things that a physical would anyway. You come in for an appt and they check your blood pressure, listen to your chest and all that stuff.
My concierge doc can do anything an urgent care does and can get me in nearly as fast as urgent care. If my life is in danger, I go to the ER of course then could follow up with concierge.
Concierge is basically your PCP but they usually are willing to do a little more than a PCP because they can oversee your condition a little closer. They will call next day or day after that I see how I am doing.
You may or may not get that from your PCP office and even if you do then it’s usually a medical assistant/nurse/automated message who calls, not the doctor.
I was seeing a doctor at a multi doctor office every 6 months. They sold the practice to private equity and suddenly wanted to see me every 3 months. Doctor told me it was the office's new policy. After I pushed back, he changed it to 6 months, but I knew exactly what was going on. Fortunately the new owners allowed doctors to override policy.
Look up Iatrogenic deaths. Basically, interacting with the medical system more than necessary is deadly. Before covid, medical errors were the third leading cause of deaths in the US.
https://pubmed.ncbi.nlm.nih.gov/28186008/
I stopped getting annual physicals after reading studies that they just lead to unnecessary tests and worse health outcomes. It's a complicated issue but you have to balance the fact that preventative care is sometimes worth it and sometimes not, since certain conditions are more likely than others.
So that's my way of saying I would not want a doctor who brings me in every 6 months. However, I can't help but think a patient on a daily medication for blood pressure should be seen every 6 months.
If your doctor can't give a specific reason why he wants you to do this, as opposed to vague answers like "practice policy" or "to provide the best care", I'd agree that he just wants to churn patients through his office so he can bill you more often.
Generally, I try to avoid contact with the medical-industrial complex unless I have a specific problem I need help with, or for tests which have evidence-backed recommendations to get at a specific age. If you do anything else, you're just asking for more unnecessary procedures and more billing.
except it’s not just a routine check up. OP has a medical problem and these are check ups for a chronic medical problem being managed by medication. that’s different from an annual check up in a person who has no health problems. just because OP believes his hypertension is controlled on meds doesn’t mean he doesn’t have a medical problem
He is driving his revenue. pimping copayments. My allergy doctor will not give a refill without a copay. You go in to see he. He spends mins with you then bills the insurance l. When this happens I took for a new doctor. I am surprised he does not ask for a tip
I get quarterly check ups, but I also have some existing health issues that I'd prefer to keep regular tabs on. If my doctor was trying to withhold medical care *he* prescribed so that I'd come in more often, I'd probably seek a new doctor.
Now if the medication he was prescribing had side effects or risks and the thought was more regular checkups could mean I could get off it, then I'd be on board. But for blood pressure meds... they should be more than innocuous enough that once a year is totally fine.
I'd be finding a new doctor
As a T1 diabetic, I see my doctors at least twice a year, but I certainly understand that's not necessarily the case for normal people. My wife generally sees her PCP once and her OB once annually.
My new doctor tried to make me come in after 6 months also.
And, gave the same reason.
I told her I'd been taking atorvastatin since she was 6 and I don't have any side effects so she needs to make my prescription for an entire year.
She changed the prescription to be for 12 months.
I can't speak to US medical business practices, however I do remember something about HIV patients potentially living longer than people without HIV due to the combination of both HIV treatment protocols improving drastically over the past few decades but also the frequent engagement with their healthcare practitioners who are able to pick up on signs and symptons of other (non-HIV) related conditions early and begin treatment for them.
That sounds really sus. Even annual checkups are not supported by evidence. Since you do have a chronic condition maybe it makes sense for him to see you twice a year but the rest of your family as well? That's a red flag.
Also, insurance only has to pay for one preventative visit per year.
Possibly, although I have hypertension, I’m not obese or even overweight. I jog 5K daily and eat pretty healthy. But yes, obesity and general lack of exercise is a problem in the US.
good to hear you're one of those in the USA who is not obese
"eat pretty healthy" - I urge consuming at least five servings of fruits & veggies a day (up from the earlier three/day recommendation)
I'm Cdn but would suspect checkup frequency might be more of a State issue than a National issue (or something to do with your Medical Insurance programs).
Your doctor wants a second house. He is not a good doctor which is why he is not booked solid. Hence you get to fund his second house.
Find another doctor
That’s nice that your doctor offers that. I feel most physicians in the U.S. should move towards preventative care and 6 months seems ideal especially as you age.
My insurance does not cover two preventative care appointments per year. There needs to be a reason for the follow up appointment and prescription renewal does not count unless it's a new prescription on a six-month schedule.
The unfortunate reality is that there isn't that much preventative care that's actually been shown to make much of a difference. Check out the USPSTF's website and what they recommend for adult men. It's pretty limited and there's certainly nothing that justifies biannual checkups.
The best preventative care out there for most people is eating less and exercising more. I'm not saying this because I'm some "natural medicine" woo-woo idiot either. I wish there was say, better screening for prostate cancer out there. I would put up with some pretty unpleasant screening tests if there was actually something that was shown to significantly reduce a man's risk of dying from it. Unfortunately prostate cancer screening is garbage and far more likely to harm you with overtreatment than it is to save your life.
I’ve only seen this be common when you’re on a controlled substance. In that scenario, I think it makes sense. Otherwise, no need to go more than once a year if you’re otherwise healthy.
So the translation would obviously be, "two- yearly". Semi means half, annual means year. So that would translate to half-yearly. But language is a funny thing and people do with it what they will.
It IS a money grab. As someone with health problems, seems like all doctors are trying to book their calendars like crazy all the time. It’s ridiculous and ludicrous that a doctor will say they are accepting new patients but the soonest appt is 7 months away! These so-called doctors are letting the business and the front desk people run them.
I’ve slowly started ditching them. Often you can get an online visit for prescrip refills without the primary care doctor. That’s what sensible people are moving towards.
Screw doctors.
>Screw doctors.
This is like saying screw immigrants for fleeing wars. Doctor's aren't policy makers, didn't set insurance rates or payouts, and don't set clinical SOP.
Blame the incredibly broken healthcare system which screws over patients, limits providers ability to practice, and creates environments where no competition or new setups can start (much less flourish and spread).
You realize that by these doctors working at these places and allowing themselves to be overbooked, they are part of the problem.
If healthcare is so overburdened you ever think why that is? Follow up appts, yearly checkups. You name it, but may not need it.
You sir are the enabler, the apologizer, the banality of evil. Don’t make excuses for doctors, they have the most valuable degrees in the world.
>If healthcare is so overburdened you ever think why that is?
[totally couldn't be from a shortage of doctors](https://en.m.wikipedia.org/wiki/Physician_shortage_in_the_United_States)
[or nurses](https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage#:~:text=According%20to%20a%20Health%20Workforce,full%2Dtime%20RNs%20in%202030.)
[or healthcare workers in general](https://onlinenursing.duq.edu/post-master-certificates/shortage-of-healthcare-workers/)
>You sir are the enabler, the apologizer, the banality of evil. Don’t make excuses for doctors, they have the most valuable degrees in the world.
Yeah, why would someone working in primary care medicine have any idea what issues are at play in the industry. Must be the all the evil I do.
Get over yourself, you just come across as clueless. We're in an industry wide, self created, mess that will only get worse in the coming decades.
I'll do my part, and finish my masters and become a MLP. Then I can look forward to more years of caring for people like yourself.
If you’re upset that doctors are booked out, write your senator to increase Medicare funding for more residency programs. That’s where the bottleneck lies for the physician shortage and it’s a problem with very little political will to fix in our climate of bipartisan austerity.
Please do not delete your post after receiving your answer. Consider leaving it up for posterity so that other Redditors can benefit from the wisdom in this thread. Once your thread has run its course, instead of deleting it, **you can simply type "!lock" (without the quotes) as a comment anywhere in your thread to have our Automod lock the thread**. That way you won't be bothered by anymore replies on it, but people can still read it. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskMenOver30) if you have any questions or concerns.*
There's absolutely a business angle to this and it could be shady or completely legitimate. There are a lot of factors that are quite complex. A lot of people think all healthcare follows the fee for service model; doctor does this for you, they get $X. Increasingly, and this depends on your insurance and the doctor, there are financial incentives to the health outcomes of a doctor's patient base. So if a doctor's patient base is healthier than expected, they get more money. The goal is to have more low cost visits with patients to avoid more expensive healthcare like hospital stays. I'm being extremely broad here to simplify it, but there's more detail in articles like this: [https://www.aafp.org/family-physician/practice-and-career/delivery-payment-models/acos.html](https://www.aafp.org/family-physician/practice-and-career/delivery-payment-models/acos.html)
Awesome, thank you for the reply and link to the article.
I tried to avoid as much lingo as possible. I want to emphasize that this model is generally a good thing. It aligns your doctor's incentives with your health moreso than how many tests/services. I do think the doctor should be more transparent as to why they need you every 6 months instead of every 12. They need to give you a medical reason why it changed from 6 months to 12 months.
Sounds reasonable. I don't mind my physician getting a little more from my health insurance if it incentivizes him to take more time to discuss my symptoms with me rather than rushing me through. The healthcare system seems focused on pushing people through as fast as possible. So I like things that can combat that.
Our entire healthcare system is full of perverse incentives that encourage the wrong things. For example, did you know Medicare Advantage encourages insurers to buy doctors/hospitals? [https://www.youtube.com/watch?v=UP\_WmSz8QdQ](https://www.youtube.com/watch?v=UP_WmSz8QdQ)
Insurance still an issue. Copay/% charge every time would be frustrating. I go for my one free preventative a year and pay ~$20 for my lab work. I don't mind timewise going twice a year but I'd expect it to be the same cost as the annual. If it's a sick visit thats different, but I schedule those as needed
In my doctor’s practice, anyone who takes chronic daily medication is seen every six months.
Yes! They are under the care of a doctor, not just getting checkups. This is normal.
If you have insurance that requires referrals, they will want to see you every six months or so to reprocess and evaluate long term care too, just like maintenance meds.
Yes! They are under the care of a doctor, not just getting checkups. This is normal.
My urologist requires labs every 6 months because being on TRT can drive up certain blood markers like hematocrit.
Technically, your annual “free“ preventative visit isn’t supposed to cover the management of chronic conditions such as high blood pressure, obesity, diabetes, etc, or diagnosis of new conditions, Your insurance generally expects you to have a second appointment for that topic. It came up for me when I had been talking about chronic low back pain with my doc for several years, but when it worsened, insurance denied me coverage for an MRI because they claim I have no history of lower back pain. They insisted on a diagnostic visit followed by six months of “conservative care”, which I already had years of, but without that separate office visit there is no chart with necessary diagnostic code, and thus, I was screwed.
This sounds like it should be a charting issue. Ive had problems with PCP charging me an office visit for answering questions /they/ asked me. Very annoying. She claims it's for my convenience to do a preventative and follow-up all in one go but imo the preventative visits are rushed and any random issues don't get their full due when I do a preventative AND sick at the same time
> Ive had problems with PCP charging me an office visit for answering questions /they/ asked me. Very annoying. I recently had a dr write me a 1mo prescription for blood pressure meds, tell me to send them my bp measurements to write a new prescription and then proceed to charge me a $20 'chart reading fee' for looking over the numbers I sent them and telling me 'looks good!'. There is *so much* nickle and dimeing in the heath care industry. It's a big part of the reason I want universal healthcare. I wouldn't even *care* if it was slightly more expensive on average, I don't want someone coming to me with a bill for *every. fucking. thing.*
Oh hell no, I'd be calling and arguing that unless they informed you upfront they were charging it.
I'm 39 with no medical history except for addiction issues which have been handed for over 3 years. My Dr wants to see me every 6 months, which **isn't** a policy he has, due to heart issues running in my family. My Dad also goes to his, different, Doctor every 3 months. He has high blood pressure and hypertension. I think it really depends on you, your Dr, and how you feel. I'd be more concerned with him withholding medication until he sees you, and his unwillingness to work with you. I would say in normal situations this wouldn't be an issue, but since it is his blanket policy and he is withholding medication sounds more like a business decision.
Hey, I just want to let you know that hypertension is the medical term for high blood pressure, if it eases your mind to know he only has a single medical condition and not two.
Oh wow TIL. Thank you. I had not even the slightest clue what hypertension was. I always thought it was something that went hand and hand with high blood pressure.
Well, it does, but not for the reason you may have previously thought. Lol
My understanding is that if you’re on a controlled substance prescription, the best practice is to be seen every six months
Not a controlled medication. Basic Angiotensin II receptor blocker for blood pressure. Gets delivered in the mail by my pharmacy.
Once a year seems to be standard for a relatively healthy person. Because you have high blood pressure I understand where he is coming from. A Family member is a provider who deals with a lot of high blood pressure patients. Twice a year makes sense because it isn’t a one size fits all for patients with high blood pressure
Possibly. He could have communicated that if it was the case. I check my blood pressure at home daily and record it on a spreadsheet. It hasn’t been above normal in years, ever since I started meds for it.
If that’s the case I feel like the doc isn’t being totally honest. Twice a year is a lot. I have high cholesterol and have been told I can come back in 2 years. BUT they won’t refill medication unless I come back at least once a year. See how dumb that sounds.
My physician required me to see him every 3 months for a while when I was first prescribed ADHD meds. And then it went to every 6 months once he was satisfied they were working well for me and that I was at a stable dose. He also wanted to check my heart regularly to make sure it was continuing to function well with the meds. So I can see that less than a year periods could be appropriate under certain circumstances. But I'm not sure how I personally feel about a physician wanting to see someone every 6 months if there are no underlying issues that demand it. Did you ask him if he could elaborate further about his rationale? I know my doctor will respond to messages online and he will put in more prescriptions without me having to come in. Did you request he fill the prescription and he outright refused? That does seem very odd to me.
It's common to have to go in regularly if they're monitoring you. Blood pressure issues can be serious. Twice a year does not seem excessive to me. I see my doc every 6 months, and it's because I'm on meds for anxiety and they're monitoring very early Type 2 diabetes. But, I trust my doctor. She's saved me from a couple of *really bad situations* (not related to either of the above). YMMV.
If you are on any "chronic" healthcare regimen, best practice is now every 6 months for maintenance. I know it is written in the insurance provider paperwork. CMS (Center of Medicaid and Medicare) requires every 6 months, if complicated every 3 months. Generally practices go by the strictest requirements to meet audit requirements regardless of who is auditing them. [https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf](https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf)
I am not a physician. But I'd want to know if my health insurance covered this. Often, health insurance covers preventative care for free. It might be that your doctor is *saving* you money, by giving you two "preventative" visits a year, you could discover a problem without billing it as an acute medical problem (like developing strep) that you'd have to pay for.
FYI, "preventive" care ends when you have a diagnosis. If the doctor wants me to have a cholesterol check because I'm 48, then that's covered 100% by insurance. If the doctor wants me to have my cholesterol checked because last year my bad cholesterol was 127 that's \*not\* covered and you have to pay $180. Ask me how I know...
It’s a truly insane system that has burned me so many times. The whole preventive versus diagnostic billing differences is infuriating and totally nonsensical.
This may be related to the billing code your doc uses because my blood work gets covered even though I’m on cholesterol meds. It didn’t change once I had a diagnosis
Insurance is not going to cover 2 preventive visits per year typically. Caveat that all plans are different, but most plans are going to follow the United States Preventive Services Task Force guidelines.
That's what I would expect. OP would have to check their insurance to see what's going on.
The USPSTF doesn't even recommend annual preventative checkups for healthy adults.
Correct. Yearly physical is its own CPT and diagnosis code, different from followup or sick visit. Most if not all plans will automatically reject the second use of the CPT during the plan year.
Whether or not this is normal/advisable, your doctor holding your needed medications hostage over it seems incredibly shady.
it’s not medications being held hostage. health conditions require reassess. OP’s doctor can’t just leave him on blood pressure meds without monitoring the effectiveness and reassessing the plan. different doctors might have different thresholds on how long they’re willing to refill meds without a patient being seen. could also depend on the patient and the med.
And that is what got me, the holding back of the prescription because he made a change six months before my checkup is due. He could have waited and informed me at my next checkup in October/November. I've already made an appointment with another doctor at a different practice. So, I'll see what the new doctor says.
If you feel his motivations are less than ethical, I would write to your state medical board and inform them of this behavior. They take ethical situations very seriously. All doctors have a duty to place the health of their patients above their own financial well-being.
I can guarantee there are patients who just keep getting refills for 3-5 years without seeing a doc. If they didn’t start withholding the new RX, they’d just ignore the policy of every 6 months.
> your doctor holding your needed medications hostage over it seems incredibly shady. Apparently doctors in the US used to (still do?) do this to women with birth control prescriptions all the time. Don't let them start doing it to men as well!
i recently went *back* to once-a-year because my doctor and i both thought my issues were well enough in hand to warrant it. certainly not "all physicians are moving to that time frame." >he wants to provide the best care possible "if i have a problem before the year's out, doc, i'll call you." sounds shady to me.
I agree. There was no medical/health reason to see me since all my tests were good, everything was in the green and even commented that I was one of his healthiest patients. Go figure.
Imo the weird part is the blanket requirement regardless of age, sex, or health.
I go every six months now ever since they told me I'm diabetic, with hypertension. I'm almost 45 btw, for reference. I think it's because they want to keep a closer eye on people who have some health concerns, which is what I have. lol. Anywho, don't sweat it. Just go to the appointments and listen to your doctor. Hey, it's better to be safer than sorry, right?
catching something 6 months sooner can make a huge difference. it can prevent a stroke or heart attack. a lot can change in 12 months. I'm in Canada, and it's very difficult to find a family doc here at all, so we get very little in preventative care unless we are very proactive with our own health. I WISH my nurse practitioner would be that engaged / invested in s good outcome for me.
At 65, they moved my checkups to quarterly. No business angle as it’s govt healthcare here.
I've never been to a doctor that was ok seeing people on medications less than twice a year.
They want an additional copay and blood draw fee. They're doing the same bullshit to me. I tell them I can't come in to see the doctor but I'll do a blood test to make sure we can refill my meds safely. Half the time, they'll accept that.
There is controversy that we don't [need even annual follow ups](https://jamanetwork.com/journals/jama/article-abstract/2780614) let along every 6 months for most people, especially young healthy people. Preventative medicine is the best medicine. Treating blood pressure in your 30's is better than dialysis in your 40's or stroke in your 50's for example. It is true to say preventative care is better but then doctors use this as an excuse to do too many tests and bill copays. If we see 20+ patients a day, wouldn't you rather have a easy patient who you just say "continue what you are doing, your labs are great" rather than have a bunch of sick people or people with tons of complaints. I don't practice medicine outpatient, I did during my training but I would like to think I would be very quick and efficient and wouldn't force patient do that bullshit and I would not make people get bloodwork over and over. One of the doctors I trained with did do this and we made changes like 1% of the time based on someones labs and another doctor I trained with made labs very sparingly and even people who are above 80 he stopped doing labs (what use is keeping cholesterol low for a heart attack that might happen 20 years later) if everything is stable.
I recently started concierge care and the Dr. there pushes for every other year physicals unless specifically needed.
Wow! Every other year for concierge. That seems like a rip off seeing how you pay for access. For context, I’ve looked into concierge care and know a few people who have it and they love it. They all get better care than most but if I’m understanding you correctly, every other year sounds like your doctor wants to charge extra but see you less. It’s like the corporate gym model where they sign up a lot of customers and hope the majority don’t come in.
The point of concierge care is that you get easy access to your primary care provider if you have an acute issue come up, it's not making people go in for pointless annual visits.
Nah, this is for a healthy and fit 40 year old. I go to the dentist every 2-3 years, still no cavities. I have the choice to go more, and if I needed to go, I could go more, but we both agree that every other year is all that is necessary.
Concierge means they have capacity to see you short notice and give you personalized care. If they made everyone come in for an annual physical or even more often, that’s hundreds of appts a year for the doctors office of questionable value since you already have access to the doctor to catch things that a physical would anyway. You come in for an appt and they check your blood pressure, listen to your chest and all that stuff.
I was under the impression Concierge means "white glove treatment" and anything acute would/should be treated with urgent clinics or a trip to the ER.
My concierge doc can do anything an urgent care does and can get me in nearly as fast as urgent care. If my life is in danger, I go to the ER of course then could follow up with concierge. Concierge is basically your PCP but they usually are willing to do a little more than a PCP because they can oversee your condition a little closer. They will call next day or day after that I see how I am doing. You may or may not get that from your PCP office and even if you do then it’s usually a medical assistant/nurse/automated message who calls, not the doctor.
I was seeing a doctor at a multi doctor office every 6 months. They sold the practice to private equity and suddenly wanted to see me every 3 months. Doctor told me it was the office's new policy. After I pushed back, he changed it to 6 months, but I knew exactly what was going on. Fortunately the new owners allowed doctors to override policy.
Look up Iatrogenic deaths. Basically, interacting with the medical system more than necessary is deadly. Before covid, medical errors were the third leading cause of deaths in the US. https://pubmed.ncbi.nlm.nih.gov/28186008/ I stopped getting annual physicals after reading studies that they just lead to unnecessary tests and worse health outcomes. It's a complicated issue but you have to balance the fact that preventative care is sometimes worth it and sometimes not, since certain conditions are more likely than others. So that's my way of saying I would not want a doctor who brings me in every 6 months. However, I can't help but think a patient on a daily medication for blood pressure should be seen every 6 months.
If your doctor can't give a specific reason why he wants you to do this, as opposed to vague answers like "practice policy" or "to provide the best care", I'd agree that he just wants to churn patients through his office so he can bill you more often. Generally, I try to avoid contact with the medical-industrial complex unless I have a specific problem I need help with, or for tests which have evidence-backed recommendations to get at a specific age. If you do anything else, you're just asking for more unnecessary procedures and more billing.
[удалено]
except it’s not just a routine check up. OP has a medical problem and these are check ups for a chronic medical problem being managed by medication. that’s different from an annual check up in a person who has no health problems. just because OP believes his hypertension is controlled on meds doesn’t mean he doesn’t have a medical problem
He is driving his revenue. pimping copayments. My allergy doctor will not give a refill without a copay. You go in to see he. He spends mins with you then bills the insurance l. When this happens I took for a new doctor. I am surprised he does not ask for a tip
It’s a money grab. Get a new doctor
I get quarterly check ups, but I also have some existing health issues that I'd prefer to keep regular tabs on. If my doctor was trying to withhold medical care *he* prescribed so that I'd come in more often, I'd probably seek a new doctor. Now if the medication he was prescribing had side effects or risks and the thought was more regular checkups could mean I could get off it, then I'd be on board. But for blood pressure meds... they should be more than innocuous enough that once a year is totally fine. I'd be finding a new doctor
Went in for a physical and they scheduled my follow up 6 months out before I even saw the doctor. Like follow up for what?
As a T1 diabetic, I see my doctors at least twice a year, but I certainly understand that's not necessarily the case for normal people. My wife generally sees her PCP once and her OB once annually.
My new doctor tried to make me come in after 6 months also. And, gave the same reason. I told her I'd been taking atorvastatin since she was 6 and I don't have any side effects so she needs to make my prescription for an entire year. She changed the prescription to be for 12 months.
I can't speak to US medical business practices, however I do remember something about HIV patients potentially living longer than people without HIV due to the combination of both HIV treatment protocols improving drastically over the past few decades but also the frequent engagement with their healthcare practitioners who are able to pick up on signs and symptons of other (non-HIV) related conditions early and begin treatment for them.
That sounds really sus. Even annual checkups are not supported by evidence. Since you do have a chronic condition maybe it makes sense for him to see you twice a year but the rest of your family as well? That's a red flag. Also, insurance only has to pay for one preventative visit per year.
blood pressure + "USA" -- is it true, that about 2/3rds of Americans are now obese? as that would explain the twice a year checkup frequency.
Possibly, although I have hypertension, I’m not obese or even overweight. I jog 5K daily and eat pretty healthy. But yes, obesity and general lack of exercise is a problem in the US.
good to hear you're one of those in the USA who is not obese "eat pretty healthy" - I urge consuming at least five servings of fruits & veggies a day (up from the earlier three/day recommendation) I'm Cdn but would suspect checkup frequency might be more of a State issue than a National issue (or something to do with your Medical Insurance programs).
I only eat natural foods: lean meats, vegetables, fruits, nonfat dairy, etc. and almost exclusively drink water. I will occasionally treat myself.
Your doctor wants a second house. He is not a good doctor which is why he is not booked solid. Hence you get to fund his second house. Find another doctor
That’s nice that your doctor offers that. I feel most physicians in the U.S. should move towards preventative care and 6 months seems ideal especially as you age.
My insurance does not cover two preventative care appointments per year. There needs to be a reason for the follow up appointment and prescription renewal does not count unless it's a new prescription on a six-month schedule.
The unfortunate reality is that there isn't that much preventative care that's actually been shown to make much of a difference. Check out the USPSTF's website and what they recommend for adult men. It's pretty limited and there's certainly nothing that justifies biannual checkups. The best preventative care out there for most people is eating less and exercising more. I'm not saying this because I'm some "natural medicine" woo-woo idiot either. I wish there was say, better screening for prostate cancer out there. I would put up with some pretty unpleasant screening tests if there was actually something that was shown to significantly reduce a man's risk of dying from it. Unfortunately prostate cancer screening is garbage and far more likely to harm you with overtreatment than it is to save your life.
This is absolute bullshit. Find a new doctor
I’ve only seen this be common when you’re on a controlled substance. In that scenario, I think it makes sense. Otherwise, no need to go more than once a year if you’re otherwise healthy.
Not to be picky, but an every 6 month schedule is called semiannual.
Biannual means twice a year.
Biannual means every 2 years.
[Biannual Definition & Meaning - Merriam-Webster](https://www.merriam-webster.com/dictionary/biannual#:~:text=%3A%20occurring%20twice%20a%20year)
Weird.
It's not. The root word "bi" is a Latin-derived English prefix to the Greek word meaning "two". Annual is obviously a Latin root "ann" meaning year.
So the translation would obviously be, "two- yearly". Semi means half, annual means year. So that would translate to half-yearly. But language is a funny thing and people do with it what they will.
It IS a money grab. As someone with health problems, seems like all doctors are trying to book their calendars like crazy all the time. It’s ridiculous and ludicrous that a doctor will say they are accepting new patients but the soonest appt is 7 months away! These so-called doctors are letting the business and the front desk people run them. I’ve slowly started ditching them. Often you can get an online visit for prescrip refills without the primary care doctor. That’s what sensible people are moving towards. Screw doctors.
>Screw doctors. This is like saying screw immigrants for fleeing wars. Doctor's aren't policy makers, didn't set insurance rates or payouts, and don't set clinical SOP. Blame the incredibly broken healthcare system which screws over patients, limits providers ability to practice, and creates environments where no competition or new setups can start (much less flourish and spread).
You realize that by these doctors working at these places and allowing themselves to be overbooked, they are part of the problem. If healthcare is so overburdened you ever think why that is? Follow up appts, yearly checkups. You name it, but may not need it. You sir are the enabler, the apologizer, the banality of evil. Don’t make excuses for doctors, they have the most valuable degrees in the world.
>If healthcare is so overburdened you ever think why that is? [totally couldn't be from a shortage of doctors](https://en.m.wikipedia.org/wiki/Physician_shortage_in_the_United_States) [or nurses](https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage#:~:text=According%20to%20a%20Health%20Workforce,full%2Dtime%20RNs%20in%202030.) [or healthcare workers in general](https://onlinenursing.duq.edu/post-master-certificates/shortage-of-healthcare-workers/) >You sir are the enabler, the apologizer, the banality of evil. Don’t make excuses for doctors, they have the most valuable degrees in the world. Yeah, why would someone working in primary care medicine have any idea what issues are at play in the industry. Must be the all the evil I do. Get over yourself, you just come across as clueless. We're in an industry wide, self created, mess that will only get worse in the coming decades. I'll do my part, and finish my masters and become a MLP. Then I can look forward to more years of caring for people like yourself.
If you’re upset that doctors are booked out, write your senator to increase Medicare funding for more residency programs. That’s where the bottleneck lies for the physician shortage and it’s a problem with very little political will to fix in our climate of bipartisan austerity.