In recent years, health care has been focused on preventive medicine. Preventive medicine emphasizes the promotion of a healthy lifestyle and proactively monitoring for various health conditions including hypertension, diabetes or cancers. To support these efforts, most commercial insurance providers now cover the cost of an annual wellness exam provided by an in-network primary care provider*. Preventive medical care is important because it provides you and your care team with an opportunity to assess your current health, which can be useful for anticipating future health care needs.
Once an in-network provider has been selected, you can schedule your annual wellness exam. A wellness or preventive exam helps your physician monitor your overall health, identify ways to keep your body and mind healthy and identify any underlying issues when they are in their earliest, most treatable stages.
What to expect at your annual wellness visit
An annual wellness visit is different from a checkup or sick visit. During the wellness visit, your provider will use screening and assessment tools to uncover any unknown medical conditions. Patients will receive a physical exam and participate in a discussion about their general well-being, including their physical and emotional health. Additional topics you may discuss with your physician include:
- Medical, social and family history
- Current medications and allergies if applicable
- Health recommendations including diet and exercise
- Medical counseling for any current health conditions or a prevention plan for those you may at a higher risk of developing
- Immunization recommendations based on age or gender
- Additional testing recommendations including blood work and age or gender appropriate screenings that may be due
What is the difference between an annual wellness visit and an office or sick visit?
It is important to understand that a wellness exam is not the same as a sick visit. Sick visits with your primary care doctor are used to evaluate new or existing conditions, pain or symptoms and can include the management of chronic health concerns. It is possible for patients to be scheduled for both a wellness and a sick visit in one day. It may also occur if a patient discusses additional concerns during a wellness visit or if a new health problem is diagnosed or discussed during the exam. In these instances, patients could be billed for both a sick and a wellness visit. The physical exam and screenings would be billed as preventive, covered benefit while the portion of the visit that relates to the treatment of the new health issue will be billed as a sick visit and applied toward your deductible or coinsurance. If the majority of the exam is spent treating medical concerns, the entire visit may be considered a regular office visit and not a wellness exam.
To successfully complete your annual wellness exam, follow the tips below:
- When scheduling your appointment, use terms like “routine preventive exam” or “annual physical” rather than requesting a “check-up”, which usually indicates follow up on an existing health problem
- At the beginning of your appointment, let your provider know you are there for your annual wellness exam
- If you have a specific, separate health problem you want to discuss during the exam, you may receive a bill after the visit for a charge related to the treatment of that problem
Rather than waiting to discuss all of your health concerns during an annual wellness exam, use this time to work with your physician on the prevention of future health conditions. Current or chronic conditions may require a diagnostic visit and various appointments to provide treatment throughout the year.
*To confirm if a provider is considered in-network for your plan, you can call the member services number listed on the back of your insurance card, or visit your insurance company’s website and use their physician finder tool.