Many insurance companies and employers are placing a renewed emphasis on wellness and preventive care. As a result, there is a trend toward plans offering a yearly preventive exam at 100% coverage (not subject to deductibles, coinsurance, and copayments). Here are the facts you need to know regarding preventive exams.
The purpose of a routine preventive exam is to identify potential health problems in the early stages when they may be easier and less costly to treat (such as hypertension, diabetes, or elevated cholesterol).
A routine preventive exam usually includes the following: a review of any intervening medical history (anything that has changed since your last visit); vital sign evaluation and review of body systems; review of medications; immunizations; counseling on risk factor reduction; review of age/gender-appropriate screening tests; laboratory exams such as cholesterol or diabetes screening. The exam is prevention-focused, not problem-focused (see below).
This exam is prevention-focused, not problem-focused. Therefore, if you have a health problem that needs to be addressed during your preventive office visit (high blood pressure, headache, diabetes, rash, etc), part of the exam may be billed for diagnosis and treatment of that condition. The portion of your visit related to the treatment of your problem would be subject to deductibles and coinsurance, just like any other problem-focused office visit.
We see patients with a LOT of different insurance plans during the day. The doctor does not know your specific benefits. You are responsible for knowing what services are covered under your plan.
You can take the following steps to help ensure your routine exam is billed correctly:
You can download a PDF copy of this policy for your records here.