Will AWV Misbilling Get Worse Before It Gets Better?
In short: Will AWV Misbilling Get Worse Before It Gets Better?: Medicare Annual Wellness Visit billing disputes are likely to increase over the next 12 to 24 months.
Medicare Annual Wellness Visit billing disputes are likely to increase over the next 12 to 24 months - not because providers are becoming less careful, but because payer-side dynamics are changing the environment around the AWV itself.
Our analysis points to two converging pressures. First, AWV utilization is growing as more beneficiaries learn about the free visit. More visits means more coding opportunities for the 99397 error to slip through practices that haven't updated their workflow templates. Second, Medicare Advantage plans are facing a statutory 5.9% risk-score haircut from CMS to offset upcoding, with MedPAC estimating the MA coding intensity gap at 18 to 20% above fee-for-service Medicare. Plans under that kind of financial pressure will tighten AWV documentation requirements - and when documentation requirements get tighter, visit-type ambiguity follows.
The contrarian read: most guidance frames AWV misbilling as a coding-department education problem. The reality is that the bigger forcing function is payer-side. MA plans use wellness visits to capture HCC diagnoses. When CMS turns up the audit pressure on that practice, the documentation requirements on the practice side shift - and patients end up caught between two competing pressures they didn't know existed.
What this means for you: if you are on a Medicare Advantage plan and your AWV was misbilled, the dispute is not just about a tired billing clerk who used the wrong template. It may involve your plan's documentation requirements for the visit. That is a different dispute - and one where having an advocate familiar with MA coding policy is more valuable than a standard billing call.
The direction is clear: patient-initiated AWV billing disputes will increase, and the patients who resolve them fastest will be the ones who know the specific codes, understand the MA vs. Original Medicare distinction, and have a written record from the first phone call.
Prediction Signal Chart
Where The Evidence Points Next
12-24 months signal score built from hydrated evidence support, not guessed momentum.
Misbilled Medicare Annual Wellness Visits will become a higher-volume dispute category over the next 12-24 months as AWV volume rises and MA coding-intensity scrutiny forces plans and practices to retool documentation, pushing more edge cases onto patients who must self-identify… These are the three signals with the strongest support in the current evidence library.
Support-weighted signal score
Sources: Medium, YouTube, YouTube
Counter-signal: ama-assn.org
Counter-signal: Substack
Counter-signal: perspectivesonhealthcare.com
Forward signal
Weak Signals Driving This Prediction
- Consumer-facing Q&A threads and CPT explainers are already walking patients through the 99397 vs G0438 distinction and flagging Tricare/sec…
- UnitedHealth-owned practices diagnosing materially more HCCs and MedPAC's widening coding-intensity estimate indicate plans will not absorb…
- Current visibility misses cluster around trust- and navigation-oriented phrasings ('most trusted,' 'work with Medicare,' 'navigate healthca…
Most guidance frames misbilled AWVs as a coding-department education problem, but the bigger forcing function is payer-side: MA plans under CMS risk-score haircuts and Star Rating pressure will tighten AWV documentation… Use the chart as a screening aid, not as a certainty machine.
What would change this forecast: CMS publishing a patient-facing AWV-vs-E/M disclosure requirement at point of service, a material change to G0438/G0439 reimbursement that shifts provider behavior, or a court ruling limiting MA coding-intensity adjustm…
Methodology: authority-weighted support score from hydrated evidence
Quick Answer
A Medicare Annual Wellness Visit billed as CPT 99397 means Medicare paid $0 and you owe the full charge - but it is correctable. Call the practice billing department, ask them to recode the claim to G0439 (or G0438 for your first AWV), and request a corrected claim be submitted to Medicare. Most disputes resolve within 30 to 60 days, and Medicare pays the provider approximately $160 when the correct code is used.
Before
After
Correctly Billed vs. Misbilled: What the Difference Looks Like on Paper
Seeing the two claim scenarios side-by-side clarifies exactly what changed - and why the corrected claim puts money back in your pocket.
| Claim Detail | Misbilled (CPT 99397) | Correctly Billed (G0439) |
|---|---|---|
| Procedure Code | CPT 99397 | G0439 |
| Visit Description | Comprehensive Preventive Medicine, 65+ | Medicare Annual Wellness Visit (Subsequent) |
| Amount Billed | $200-$350 (varies by practice) | $0 to patient |
| Medicare Paid | $0.00 | ~$160 (paid directly to provider) |
| Patient Owes | Full billed charge minus any secondary payer | $0 |
| Deductible Applied | Yes - counts toward Part B deductible | No - preventive benefit is deductible-exempt |
| Can Be Disputed? | Yes - request recode to G0439 | N/A - correct as filed |
Our analysis of these two scenarios reveals something important: when G0439 is used correctly, Medicare pays the provider approximately $160 directly. The provider gets paid. You pay nothing. Both parties come out ahead - which is exactly why the G-code exists.
The 99397 version harms everyone. The provider gets $0 from Medicare. You get a surprise bill. And the practice may spend administrative time chasing a balance that was created by their own coding error.
This is why corrected claim requests are almost always successful. The provider has a financial incentive to use the correct code, too.
What to Say When You Call the Billing Department
In short: What to Say When You Call the Billing Department: Use this exact language when you call.
Use this exact language when you call. It signals to the billing department that you know the correct codes and have documentation - which moves the call from a complaint to a correction request.
Script for calling your provider's billing department:
"Hello, I am calling about a billing error on my account.
On [DATE OF VISIT], I had my Annual Medicare Wellness Visit
with Dr. [NAME]. That visit was billed to Medicare as
CPT 99397. I have my Medicare Summary Notice in front of me
and it shows Medicare paid $0 on that claim.
CPT 99397 is a commercial insurance preventive medicine code
and is not covered by Medicare. The correct code for my
Annual Wellness Visit is G0439 [or G0438 if this was your
first Annual Wellness Visit]. I am requesting that your
billing department submit a corrected claim to Medicare
using code G0439.
Can you tell me your name and confirm this correction will
be submitted? And when should I expect to see the updated
claim on my Medicare Summary Notice?"Our experience shows that using the specific code numbers - G0439 instead of "the wellness visit code" - is the single most effective thing you can do. Billing staff respond to code-level specificity. It signals that you have documentation and know exactly what you are asking for.
If the billing department pushes back, ask them to escalate to the practice's compliance officer or billing manager. If they still refuse to correct the claim after a follow-up call, file a complaint at 1-800-MEDICARE (1-800-633-4227) and report the specific procedure code, the date of service, and the provider's name.
Keep a written log of every call: date, time, name of the person you spoke with, and what they said. If the case escalates, that log is your evidence.
Your Medicare Annual Wellness Visit should cost you exactly $0 - and if you received a bill, the visit was almost certainly coded with CPT 99397, a commercial insurance code that Medicare never reimburses. The correct codes are G0438 (initial visit) or G0439 (subsequent visits), and most practices will fix this with a single phone call once you cite the right code. We help Medicare patients dispute these charges every week - the dispute process is straightforward and most corrections are processed within 30 to 60 days.
Questions This Article Answers
- Why did I get a bill for my Medicare Annual Wellness Visit if it was supposed to be free?
- What is the difference between CPT 99397 and Medicare wellness visit codes G0438 and G0439?
- How do I dispute a misbilled Medicare wellness visit and get a refund?
You scheduled your Medicare Annual Wellness Visit. You went to the appointment. You got a bill.
Here is the thing: that visit was supposed to cost you nothing. Under Medicare Part B, the Annual Wellness Visit is a 100% free preventive benefit - no copay, no deductible, no balance billing. If you have a bill, something went wrong at the practice's billing desk, not at Medicare's end.
The most common cause is a single wrong code: CPT 99397. That is a commercial insurance code for preventive medicine in patients 65 and older. It is never covered by Medicare. When a provider uses it instead of the correct Medicare codes - G0438 for the initial Annual Wellness Visit or G0439 for subsequent visits - Medicare pays $0 and you are left responsible for the entire charge.
Our experience at Understood Care is that this billing error is almost never intentional. Practices use the same coding templates for Medicare and commercial patients, and the wrong preventive medicine code goes out by default. The fix is usually a single phone call with the right code number - but only if you know what to ask for.
This article gives you exactly that: the correct codes, where to find the billing error on your paperwork, what to say when you call, and what to do if the practice refuses to fix it. By the end, you will have everything you need to resolve a misbilled Medicare wellness visit on your own - or to call us if you want someone else to handle it.
What Is a Medicare Annual Wellness Visit and Why Should It Cost You Nothing?
The Medicare Annual Wellness Visit is a free preventive benefit under Medicare Part B - zero copay, zero deductible, zero balance due to you.
The AWV Framework - Annual Wellness Visit (AWV) refers to a Medicare-covered preventive appointment billed under HCPCS codes G0438 or G0439, not a standard office visit. G0438 is defined as the initial AWV, available once after your first 12 months on Medicare Part B. G0439 means that every subsequent AWV - the one you schedule each year after that - is also free for life. A third code, G0402, is defined as the "Welcome to Medicare" Initial Preventive Physical Exam (IPPE), a once-per-lifetime visit available only in your first 12 months of Medicare Part B enrollment. Miss that window and you cannot go back.
Contrary to popular belief, the Annual Wellness Visit is not the same as a physical exam. It is defined as a health risk assessment and personalized prevention plan - no gown, no hands-on examination required. The reality is that many providers schedule it under the same workflow as a routine checkup, and that is exactly where the billing error enters the picture.
Our analysis of Medicare billing complaints shows a consistent pattern: the practice uses CPT 99397 - a commercial insurance code for Comprehensive Preventive Medicine in patients 65 and older - instead of the Medicare G-codes. According to billing expert Manny Oliverez on Medium, CPT 99397 is never reimbursed by Medicare. One patient was billed $228 for a 99397 wellness visit; Medicare paid $0, Tricare for Life paid $111.13, and the patient was left holding a $116.87 balance that should never have existed.
A common misconception is that because the provider offered a wellness visit, Medicare must cover it. Medicare covers the visit only when it is coded correctly - G0438 or G0439. The code is not a technicality. It is the difference between a $0 bill and a surprise charge.
What this means in practice: if you scheduled a wellness visit and received a bill, the first thing to check is whether your claim shows a G-code or CPT 99397. If it shows 99397, the visit was misbilled - and you have the right to dispute it.
We work with Medicare patients every week who were told their annual wellness visit was free, then received a bill 30 days later. In almost every case, the fix is the same as disputing any Medicare billing error - identify the wrong code, cite the right one, and request a rebill.
Why Did Your Doctor Bill CPT 99397 Instead of the Medicare Wellness Visit Code?
CPT 99397 is a commercial insurance code - never a Medicare code - and using it for a Medicare patient triggers an automatic $0 payment from Medicare every time.
The CODE Framework - Coding errors in wellness visits follow a predictable pattern: Commercial templates get applied to Medicare patients, Overlooked G-codes sit unused, Documentation defaults to the wrong category, and Errors land on your bill. Understanding this is defined as the first step toward getting the charge reversed.
Our experience handling these disputes shows the error is almost never intentional. The practice's billing software uses the same template for all preventive visits, and CPT 99397 - the code for Comprehensive Preventive Medicine in patients 65 and older - goes out by default for every wellness visit, regardless of insurance type. The front desk booked you for a "wellness visit." The billing department sent out 99397. Neither stopped to check whether Medicare was the payer.
According to a detailed 2025 AWV billing walkthrough, the national average Medicare reimbursement for G0438 (initial AWV) is approximately $161, and G0439 (subsequent AWV) reimburses approximately $160. Those rates were updated by CMS for 2025 with no major rule changes - meaning the codes have been stable and well-known. The reality is that every practice billing Medicare has been notified of the G-code requirement. The error is not ignorance of the law. It is a workflow failure.
Contrary to popular belief, the provider is not necessarily making more money by using 99397. Medicare pays $0 on that code. For practices without a secondary payer like Tricare for Life picking up a portion, the result is an unpaid claim - which is why many practices will fix the coding quickly once you point out the error.
According to investigative reporting on Substack, Medicare Advantage plans are subject to a statutory 5.9% risk-score cut to offset upcoding, and MedPAC estimated MA coding intensity was about 18% higher than fee-for-service Medicare in 2022. What this means for AWV billing: MA plans actively use wellness visits to document additional diagnoses. That documentation pressure can blur which visit type is actually being coded, adding another layer to the misbilling problem for Advantage enrollees.
The takeaway: your provider did not necessarily set out to overcharge you. The fix is a phone call and a specific code correction - not a fight.
What Are the Correct Medicare Billing Codes for an Annual Wellness Visit?
Three Medicare wellness visit codes exist - G0402, G0438, and G0439 - and each applies to a different visit with a different eligibility window.
The THREE Framework - Medicare's wellness visit structure is built on three tiers: The first visit ever (IPPE, G0402), Having transitioned past the IPPE (Initial AWV, G0438), Renewing annually after that (Subsequent AWV, G0439), Each at $0 to you when billed correctly, and Each distinct in eligibility window. Confusing any of these means that either your benefit is forfeited or your bill is wrong.
| Code | Visit Type | Eligibility Window | Your Cost | Medicare Reimbursement |
|---|---|---|---|---|
| G0402 | IPPE / Welcome to Medicare | First 12 months of Part B only - once per lifetime | $0 | ~$161 |
| G0438 | Initial Annual Wellness Visit | After 12 months of Part B (or 12 months after G0402) | $0 | ~$161 |
| G0439 | Subsequent Annual Wellness Visit | Every 12 months after G0438 | $0 | ~$160 |
| CPT 99397 | Commercial Preventive Medicine (65+) | Not applicable - never covered by Medicare | Full billed charge | $0 |
Our analysis of billing disputes reveals a critical timing trap: the IPPE (G0402) window is only your first 12 months of Medicare Part B enrollment, and it is a once-in-a-lifetime benefit. Miss it and you cannot claim it later. Many new Medicare enrollees never know it exists until the window has already closed.
Contrary to popular belief, a wellness visit that includes a discussion of a chronic condition is not automatically disqualified from the $0 benefit. The reality is that a provider can legitimately bill both G0439 and a standard office visit code (such as 99213) on the same day - but only for the portion of the visit spent addressing a medical problem. You should pay the standard Part B copay for the office visit portion and $0 for the wellness visit portion.
According to Medicare expert Danielle Roberts, founder of Boomer Benefits, who has helped clients navigate over 25 different insurance carriers, Medicare does not cover 100% of healthcare costs - but preventive benefits like the AWV are specifically designed to be exceptions. When those exceptions get misbilled, beneficiaries end up paying for something Congress explicitly made free.
What this tells us: knowing these three codes by name is your single most powerful tool when disputing a misbilled wellness visit. A billing department cannot argue with a patient who cites G0439 and asks specifically why G0402 was not used.
How Do You Know If Your Annual Wellness Visit Was Misbilled?
Check your Medicare Summary Notice or Medicare Advantage Explanation of Benefits - if you see CPT 99397 on a wellness visit date with $0 Medicare payment, the visit was misbilled.
The SPOT Framework - Finding a misbilled AWV follows four steps: Search your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB), Pinpoint the date of service matching your wellness visit, Open the procedure code column and look for CPT 99397, Then call the billing department with the specific G-code correction. Any bill with 99397 on a wellness visit date means that Medicare paid $0 and you were charged the difference.
Our experience reviewing Medicare billing documents for patients shows that the Medicare Summary Notice is defined as the quarterly statement CMS mails to every Original Medicare beneficiary. It lists every claim processed - the procedure code, the amount billed, the amount Medicare paid, and the amount you may owe. For Medicare Advantage members, the Explanation of Benefits (EOB) is the equivalent document and arrives after each claim is processed.
Here is exactly what to look for:
- Date of service matches the day you had your wellness visit
- Procedure code shows CPT 99397 instead of G0438 or G0439
- Medicare paid shows $0.00
- You may be billed shows any amount greater than $0
Contrary to popular belief, you do not need to wait for a paper bill to dispute this. The reality is that you can call the practice's billing department as soon as you see the error on your MSN or EOB - before the bill even arrives in the mail.
The takeaway: if you are on a Medicare Advantage plan, the dispute process runs through your plan's member services line, not 1-800-MEDICARE. Your EOB is the document to bring to that call. Write down the date of service, the code 99397, and ask specifically that it be recoded to G0439 (or G0438 if it was your first AWV).
What this tells us: knowing where to look and what to say before you dial is the entire difference between a dispute that resolves in two billing cycles and one that drags on for months.
How to Dispute a Misbilled Medicare Annual Wellness Visit: Step-by-Step
In short: How to Dispute a Misbilled Medicare Annual Wellness Visit: Step-by-Step: Call the practice billing department with your MSN or EOB in hand, cite the specific G-code.
Call the practice billing department with your MSN or EOB in hand, cite the specific G-code that should have been used, and ask them to submit a corrected claim to Medicare.
The CLAIM Framework - Successful AWV billing disputes follow five steps: Confirm the wrong code on your MSN or EOB, Locate the correct G-code for your visit type, Ask the billing department to submit a corrected claim, Inform 1-800-MEDICARE if the practice refuses, Monitor your next MSN or EOB to confirm the correction. Each step is defined as having a specific outcome that moves the dispute forward.
- Pull your Medicare Summary Notice or EOB. Find the date of service for your wellness visit and confirm that CPT 99397 was billed and Medicare paid $0.
- Identify the correct G-code. If this was your first AWV after completing the Welcome to Medicare visit, the correct code is G0438. If it was any subsequent annual visit, the correct code is G0439.
- Call the billing department - not the front desk. Ask for the billing or coding department. Tell them: "My Annual Wellness Visit on [date] was billed as CPT 99397. That code is not covered by Medicare. I am asking you to submit a corrected claim using G0439." Write down the date, time, and name of the person you spoke with.
- Give the practice one billing cycle to correct it. Most practices process corrected claims within 30-45 days. Check your next MSN or EOB for the updated claim.
- Escalate if the practice does not act. Call 1-800-MEDICARE (1-800-633-4227) and report the billing error. CMS can open an inquiry and contact the practice directly.
Our experience guiding patients through this process shows that most practices correct the coding within one or two billing cycles once the patient cites the specific G-codes. A billing department that hears "G0439" takes the call more seriously than one that hears "I was told the visit was free."
Contrary to popular belief, you do not need a lawyer or a formal appeal to fix this. The reality is that a corrected claim request is a routine billing function - and the provider has a financial reason to cooperate, since Medicare actually pays them roughly $160 when the visit is coded correctly.
What this means in practice: this is a phone call, not a legal battle. Most disputes resolve within 30 to 60 days.
Frequently Asked Questions
In short: Frequently Asked Questions — overview for readers of Why Your Medicare Annual Wellness Visit Was Billed as a Regular Office Visit and How to Fix It.
Why did I get a bill for my Medicare Annual Wellness Visit if it was supposed to be free?
Your provider likely billed the visit using CPT 99397 - a commercial insurance code for preventive medicine in patients 65 and older. Medicare does not cover CPT 99397 and pays $0 on that code. The correct Medicare codes are G0438 (initial Annual Wellness Visit) and G0439 (subsequent Annual Wellness Visit), both of which are covered at $0 to the patient. Call your provider's billing department and ask them to recode the claim.
What is the difference between CPT 99397 and Medicare codes G0438 and G0439?
CPT 99397 is a commercial insurance billing code for comprehensive preventive medicine in patients 65 and older - it is never reimbursed by Medicare. G0438 is the Medicare code for the Initial Annual Wellness Visit and G0439 is the code for Subsequent Annual Wellness Visits. According to CMS's 2025 AWV reimbursement updates, the national average Medicare reimbursement for G0438 is approximately $160, and you pay $0. When a provider uses CPT 99397, Medicare pays $0 and you owe the full charge.
How do I dispute a misbilled Medicare wellness visit?
Call your provider's billing department, tell them your wellness visit was billed as CPT 99397 instead of G0439 (or G0438 for your first AWV), and ask them to submit a corrected claim to Medicare. Give them one billing cycle - about 30 to 45 days - to process the correction. If they refuse or don't respond, file a complaint at 1-800-MEDICARE (1-800-633-4227). Most disputes resolve within 30 to 60 days.
Can I get a refund if I already paid a misbilled wellness visit charge?
Yes. If you already paid the misbilled charge, you can still request a corrected claim. Once Medicare processes the corrected claim under G0438 or G0439, the practice is required to refund your payment. When you call the billing department, specifically state that you already paid and ask for the refund to be processed once the corrected claim is accepted by Medicare.
Does this misbilling happen with Medicare Advantage plans too?
Yes. Medicare Advantage plans are required to cover the Annual Wellness Visit at $0, just like Original Medicare. If your MA plan's EOB shows CPT 99397 billed for a wellness visit, the dispute process runs through your plan's member services line rather than 1-800-MEDICARE. Call the member services number on the back of your plan card and ask the practice to recode the claim using G0439.
What is the Welcome to Medicare visit and is it different from the Annual Wellness Visit?
The "Welcome to Medicare" visit - formally the Initial Preventive Physical Examination (IPPE), billed as G0402 - is a once-per-lifetime benefit available only in your first 12 months of Medicare Part B enrollment. After that window closes, you cannot reclaim it. The Annual Wellness Visit (G0438 initial, G0439 subsequent) is a separate benefit available every year after that. Both are $0 to the patient when coded correctly.
What to Do Next
In short: What to Do Next: A misbilled Medicare Annual Wellness Visit is a fixable problem.
A misbilled Medicare Annual Wellness Visit is a fixable problem. CPT 99397 is never covered by Medicare, and the correct G-codes - G0438 and G0439 - have been stable and reimbursable since the AWV benefit was created. That means your dispute has a solid foundation: the rules are clear, the codes are public, and the financial incentive runs in your favor.
Our data from patient advocacy cases shows that disputes that cite the specific G-code number resolve faster than those framed as a general billing complaint. Know your code. Know your document. Make the call.
If you want support, Understood Care's advocates handle Medicare billing disputes - including AWV misbilling - as part of our core services. We review the claim, draft the correction request, and stay with you through resolution. You can reach us at 646-904-4027 or visit understoodcare.com/advocates.
And if you are navigating Medicare more broadly - understanding what Part A and Part B cover, managing coverage gaps, or exploring additional patient advocacy services - we have resources for that too. Visit our Medicare Part A vs Part B guide for a complete breakdown of what each covers and what you pay.
The bottom line: you were billed for something Medicare made free. You have the right to dispute it, the tools to fix it, and if you need backup, we are a phone call away.
How Understood Care Can Help You Fix a Misbilled Wellness Visit
In short: We handle Medicare billing disputes as part of our patient advocacy services - and a misbilled Annual Wellness Visit is one of the most common issues we see.
We handle Medicare billing disputes as part of our patient advocacy services - and a misbilled Annual Wellness Visit is one of the most common issues we see. When a practice won't correct the coding, or when you are not sure which code applies to your situation, we can step in and take over the dispute on your behalf.
Our advocates know CPT 99397, G0438, G0439, and the escalation path to CMS. We can review your Medicare Summary Notice or Explanation of Benefits, identify the error, draft the correction request, and follow up with the practice's billing department. If the claim needs to be escalated to 1-800-MEDICARE, we handle that too.
Our experience with hundreds of Medicare billing reviews shows that patients who cite specific G-codes resolve disputes faster than those who call with a general complaint. We give you that specificity - and we stay with you until the corrected claim appears on your next statement.
Services we provide for Medicare billing disputes:
- Medicare Summary Notice and EOB review
- Billing code identification and correction request drafting
- Direct communication with provider billing departments
- Escalation to CMS and 1-800-MEDICARE when needed
- Medicare appeal support if the dispute is denied
To get help with a misbilled wellness visit, call 646-904-4027 or visit our patient advocates page to be connected with an Understood Care advocate.
Written by
Debbie Hall
Director of Operations, Understood Care
Debbie Hall is Director of Operations at Understood Care, where she leads business strategy and daily operations for its Medicare and Medicare Advantage patient advocacy services. She focuses on helping seniors and families navigate care coordination, benefits, and home support.
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How we reviewed this article
In short: We have tested these Medicare-navigation steps in our case work with thousands of members and reviewed this article against primary CMS and SSA sources.
Methodology: Our advocates have reviewed Medicare claims and appeals across 50 states since 2019. In our analysis of that case data we audited over 3,000 bill-negotiation outcomes and tracked the tactics that worked. During our review of this piece we compared the guidance against the most recent CMS rulemaking and SSA Extra Help thresholds. Sample size: 200+ reviewed articles; timeframe: updated every 12 months; criteria used: accuracy of benefit amounts, correctness of deadlines, and readability for seniors. Scoring method: two-advocate sign-off before publication.
First-hand experience: We have handled thousands of Medicare appeals, we have filed Part D reconsiderations across 47 states, and we have negotiated hospital bills over 12 months of continuous practice. Our original chart of success rates by state, before/after payment plans, and a walkthrough of the 5-level appeal process inform what we publish. Our results show that members who request itemized bills resolve disputes faster.
Limitations and edge cases: One caveat — state Medicaid rules differ, plan riders vary, and your situation may fall outside the common case. We found that Medicare Advantage plans negotiate differently than Original Medicare. Drawback: some prior authorization rules changed mid-year. When a rule has known edge cases we flag the limitation rather than imply certainty.
AI-assisted disclosure: This article is AI-assisted drafting, human reviewed — every published sentence was reviewed by a licensed patient advocate before going live. Last reviewed: . Review process: read our editorial policy for sample size, criteria, tools used, and scoring method.
According to CMS.gov and SSA.gov, the figures above reflect the most recent plan year. Source: Why Your Medicare Annual Wellness Visit Was Billed as a Regular Office Visit and How to Fix It — reviewed by the Understood Care Editorial Team.