It’s that time of year when you should make an appointment with your primary care physician for your annual checkup. You may be unaware that the type of visit you schedule has financial ramifications. Continue reading to learn the distinctions between a physical, a wellness exam, and chronic condition care.
Annual Physical Exams
How Is Care Provided?
Annual physicals are more “physically” thorough exams that are usually performed by a doctor, nurse practitioner, or physician assistant. The provider will visually examine your body, feel/palpate/tap soft-tissue areas, and use a stethoscope to listen to your body’s sounds. Don’t forget to done annual check up.
What to expect during your annual physical examination:
- Check your height and weight.
- Check your blood pressure
- Examining body mass index (BMI) measurements
- Examine your medical and family history
- Risk factor evaluations
- Check your vital signs
- Physical examinations such as head and neck, abdominal, and neurological examinations
In-Person or Remote Visit
Because of the physical nature of the exam, it is usually given in person.
“In general, even the healthiest patients need an annual physical,” says Veronica Smalheiser, ANP-BC, AGNP-C, CVNP-BC, a nurse practitioner. “It allows us to meet face to face and conduct a thorough examination.” Many issues cannot be addressed or discovered without direct patient contact.”
How Is Medical Care Billed
An annual physical exam is not covered by Medicare. Some commercial insurance plans consider this a preventive care visit if no new symptoms or the management of an ongoing, or chronic, health problem are discussed. Many plans cover one annual preventive care visit completely, but there may be a visit copay if you seek care for new symptoms or ongoing issues.
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How Is Care Provided?
A wellness exam or visit is designed to help you live a longer, healthier life. This type of preventive care focuses on keeping you healthy and detecting any health problems before they become a problem. Is annual physical exam covered by insurance?
Medicare wellness visits, which are usually performed by a nurse, include assessments but not “physical” tests in which the provider must physically touch you. The goal of the Medicare wellness visit is to create a baseline for future care by painting a picture of your current state of health.
What to expect from your wellness examination:
- Keeping track of your height, weight, blood pressure, and other regular measurements
- A risk assessment for health (questions you answer about your health)
- An examination of your medical and family history
- Creating or updating a list of your current healthcare providers and prescriptions
- Examine for signs of memory loss or dementia, as well as depression, anxiety, and stress.
- Discussion of your risk factors and potential lifestyle changes or treatment options
- A schedule for screening for appropriate preventive services (as needed)
In-Person or Remote Visit
Medicare allows wellness exams to be performed via virtual platforms, and primary care providers have been providing patients with this convenient option. Simply call your provider’s office to set up a virtual wellness exam.
Some commercial insurance plans require wellness exams to be performed in person. Call to confirm coverage if you prefer to use telehealth for your visit.
According to Smalheiser, “a wellness examination focuses on screening evaluations, updating ongoing clinical processes, and addressing non-medical issues that may affect your health.” “This can sometimes be done through telehealth.” Regardless of how healthy you believe you are, a wellness examination can address a variety of issues as you reach milestones and age.”
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How Is Medical Care Billed?
While wellness exams are typically covered by insurance, your insurance may not cover all associated costs, such as labs or tests. Most insurance companies cover one wellness exam per year.
Annual wellness visits (once every 12 months) are covered by Medicare without a copay, and these visits are not subject to a Part B deductible. You may, however, be required to pay a portion of the cost for certain recommended tests or services.
Many commercial insurance plans no longer consider a wellness visit if new symptoms or management of an ongoing health problem are discussed. The visit is now classified as a sick or chronic condition visit, and copays or coinsurance may be required.
Chronic Disease Treatment
The fact that chronic conditions may fall outside of what your health insurance considers preventive care does not diminish the importance of managing those you may have. It is critical to monitor how well your medications are working and how your current lifestyle affects any chronic conditions, such as high blood pressure and diabetes, for your overall long-term health.
“Telehealth can be a bridge until the next in-person office visit for routine, ongoing follow up,” Smalheiser says. “Routine discussions about ongoing management and disease progression may be adequately addressed during visits.”
Mcgowan Family Health and Wellness Centre has a wide range of experienced and high-qualified doctors who provide annual physical exam services. You get information about the annual physical exam by age. For assistance, you can call us anytime at (708) 480 9730.