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Annual exams mean different things to insurance companies and patients. Here are some tips to help you decide what type of appointment to make.
What is a wellness exam?
A wellness exam is a comprehensive preventative exam with your primary care provider for the sole purpose of preventative care. A wellness exam does not include discussion of new problems or management of chronic conditions. These exams may also be called annual exams, routine check-ups, yearly exams, an annual pap, or preventive visit.
Will my insurance pay for a wellness exam?
Most health plans will pay for one wellness or preventative exam per year. Your insurance provider may consider this to be once per calendar year. If you have had any other visit billed as preventative during this time period your plan is likely to deny your wellness exam. This would include a well-woman exam or pap smear. Your plan may not pay for all testing and/or labs ordered during your wellness exam. If your provider has a concern and orders diagnostic testing and/or labs during your exam you may be billed separately.
What is the difference between a wellness exam and a problem visit?
Problem visits and testing are used to diagnose or manage a current health problem. For example, your provider might want you to have a test because of your age or family history, that’s preventive care, but if it’s for monitoring a problem you already have like high blood pressure or diabetes that’s diagnostic care.
Can I have a wellness exam and problem visit at the same time?
These can be done on the same day, but this can complicate the billing for the visit, and result in a patient balance for the visit. If possible, please schedule a separate appointment, on a different day, if you have any new concerns or other ongoing health problems that need more attention. Should your wellness exam turn into a diagnostic or problem-oriented visit your provider may discuss this with you and bill accordingly.