> If I bring up any health issues I'd like to discuss at my annual exam, it's billed as a doctor visit because it's no longer "preventative" care. For the visit to be free, I have to stay silent. It also gives providers an opportunity to recommend and order expensive tests or procedures that the patient might otherwise not have pursued.

They tried to bill me for that in the past at practices I was a patient of. There's a fine line between preventative care and E/M. You can generally walk the "preventative care" line by presenting your concerns as an observed change to be documented rather than a problem to be solved.

If they do charge you, call the office to appeal the billing and they generally drop it as long as you can push the point that you weren't seeking a specific treatment but rather were just informing the doctor of a change in your health or conditions since the last visit.

Oh yea just call and talk to someone its easy and its not like you are going to be put through the ringer talking to 10 different people over several weeks inexplicably over several continents.

I've not found that to be an issue with smaller practices. Most of the times small practices just have one person other than the doctor who deals with billing. Sure they often outsource past that but if you can get either the doc or that person, they'll often just change the codes because even if they can technically bill you, it's probably not worth the time or effort for them.

But yeah at big practices good luck. They are a living nightmare to deal with and I feel for anyone who can't get access to a smaller (ideally solo) practice.