When its time for your annual physical, you know how you typically think of medical stuff to ask the doctor?

Well, dont do that anymore. Stop thinking. And keep your mouth shut unless you have a serious health concern, such as erectile dysfunction or pending death.

That was the lesson learned by Diane R., a 52-year-old Boylston resident who didnt want her name used, lest her health care provider suddenly decide that hey, those important tests actually arent covered under section R2D2, and she also happens to need a daily colonoscopy.

Diane underwent a physical in November, now called a wellness visit, which is covered under her health insurance plan with no co-pay. During the visit, she happened to mention a minor ankle pain. The doctor looked at it and the ankle appeared normal, so he basically told her she could get an X-ray if the pain didnt subside.

Two months later, Diane and her husband were surprised to receive a doctors bill for a $45 co-pay for the physical. Her husband called UMass Memorial Medical Center and was told that, yes, the exam was free. But the co-pay was charged because Diane had the temerity, during her annual physical, to ask about a medical condition. If you can believe the nerve. So in a nifty sidestep of the space-time continuum, she was charged for a second visit within the same time frame of the original visit.

Dianes husband was understandably baffled. He followed up with a call to Tufts Health Plan, his wifes insurer, and got the same answer. He was also told that Tufts was billed $277 for the physical, and $188 for the casual ankle question, which took her doctor a whopping two minutes to answer. The bills reflected two visits on the same date and time.

According to Einstein, this time-multiplier phenomenon doesnt exist, but I guess it does in the world of medical billing, Dianes husband said.

Clearly, we laypeople lack the advanced medical training needed to understand that a medical exam should not include actual medical questions for the doctor. These days, annual wellness visits are intended for basic maintenance, and youre not supposed to bother the doctor with arcane problems such as back pain, fatigue, your bum knee or the 12-inch machete protruding from your forehead. All of those issues cost extra.

Free annual wellness visits have been offered by Medicare since January 2011 as part of the Affordable Care Act signed into law by President Barack Obama, and Medicares protocol often becomes standard throughout the health care industry. The ACA targets waste, fraud and abuse, and the Department of Health and Human Services has been instructed to impose quality and efficiency measures on hospitals and doctors.

The bottom line is, (wellness visits) are indeed a tricky area, said Dr. David Fairchild, senior vice president for clinical integration at UMass. The annual physical doesnt cover problems. The doctor is obligated legally to bill those as separate complaints because theyre not a health maintenance issue.

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Free wellness visit (Health care extra)