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Important Information Regarding Your Annual Wellness Exam for Insurance or Access Patients

We are pleased you are taking a proactive approach to your health by scheduling your annual wellness exam! To ensure you get the most out of your visit and understand how it will be billed to your insurance, please review the following:

What is an Annual Wellness Exam?

An Annual Wellness Exam (sometimes called a preventative or routine physical) is a preventative service focused on maintaining your current health and preventing future illness. It typically includes:

Review of your medical and family history.

Health risk assessments (e.g., screenings for depression, alcohol use).

Immunization review and recommendations.

Age and risk-appropriate preventative screenings recommendations (e.g., mammograms, colonoscopy).

Routine measurements like blood pressure, height, and weight.

Counseling on maintaining a healthy lifestyle.

Billing for Your Wellness Exam (Important!):

When we bill your insurance, we use specific codes to indicate the type of visit:

Preventative/Wellness Visit Code: This code is used when the visit focuses only on the items listed above. Most insurance plans cover preventative services at no cost to you (no copay, deductible, or coinsurance).

Diagnostic/Problem Code: This code is used when a visit addresses a specific new or existing medical problem (e.g., a cough, headache, joint pain, managing uncontrolled diabetes, discussing a new rash, etc.).

Crucially, if you discuss or are treated for a new or existing medical condition during your wellness exam, your provider is legally required to bill the visit as a combined Preventative AND Diagnostic/Problem visit.

What Cannot Be Included in a Pure Wellness Visit:

To ensure your visit is billed only as a preventative service (and avoids a potential copay or deductible charge):

We cannot address new symptoms or complaints (e.g., "I've had this terrible headache for a week," or "I need you to look at this knee pain.").

We cannot manage or follow up on chronic, ongoing conditions that require in-depth discussion, medication changes, or new orders/testing (e.g., a complicated follow-up for high blood pressure or diabetes).

Our Recommendation:

If you have a specific medical problem or concern you want to discuss, or if you need to follow up on a complex chronic condition, we recommend scheduling a separate appointment specifically for that issue.

This ensures your Wellness Exam remains free of charge (per your plan's benefits) and allows your provider the necessary time to thoroughly address both your preventative care and your specific medical concerns in dedicated appointments.

By proceeding to schedule your Annual Wellness Exam, you acknowledge and understand these billing guidelines.

If you have questions about your specific insurance coverage, please contact your insurance provider directly.