Understanding Your Preventive Visit and Potential Costs

A preventive visit — also called an annual wellness exam, annual physical, or well-woman exam — is a scheduled visit focused on maintaining your overall health, updating your health history, reviewing your medications, and catching potential health problems early through screenings and preventive care.

Under most health insurance plans, including Medicare and plans governed by the Affordable Care Act, preventive visits are covered at no cost to you — meaning no co-payment, deductible, or coinsurance applies when the visit is billed as a preventive service.

Even if your insurance covers preventive visits, you may receive a separate bill if your provider addresses a medical problem, diagnoses a new condition, or performs a service that does not qualify as preventive care during the same visit.

Your insurance company — not our office — determines how a visit is classified and billed based on the diagnosis and service codes we are required to submit. We are contractually obligated to code all visits accurately and completely.

Common situations that may result in additional charges:

• You mention a new symptom or health concern that your provider evaluates and documents during the visit (for example: back pain, a rash, fatigue, or shortness of breath)
• Your provider reviews or adjusts management of a chronic condition such as high blood pressure, diabetes, or high cholesterol
• Your provider orders laboratory tests related to a specific medical concern rather than routine preventive screening
• Your provider orders or performs a procedure related to a new or existing condition — for example, an EKG for chest pain or elevated blood pressure reported during the visit
• You need a prescription, referral, or follow-up plan related to a non-preventive issue

When your provider documents and treats a medical concern during the same visit as your preventive exam, your insurance company requires that we submit separate billing codes reflecting the full scope of services provided. We are not able to omit accurate clinical information from your record or billing codes to avoid additional charges — doing so would violate our insurance contracts and applicable law.

This is a standard insurance billing requirement that applies across most health plans. If you have questions about your specific coverage, we encourage you to contact your insurance company directly.

• Review your insurance plan's benefits before your visit to understand your preventive versus problem-focused coverage
• Contact your insurance company directly with specific questions about your plan
• Speak with our staff before or during your visit if you have concerns about potential costs — we can help you understand what to expect
• If you would prefer to address non-urgent medical concerns at a separate appointment, please let your provider know at the start of your visit

If you have questions about your bill after your visit, please contact our billing office at 770-458-8497. We are happy to review your charges and explain how your visit was coded.