Preventative Visit Vs. Problem Visit

What is an Annual Preventative/Wellness Visit?

Preventive visits typically are annual visits or well-child exam visits to your physician that are prevention-focused.  An annual exam does not include discussion of new problems or detailed review of chronic conditions. Annual exams may also be called routine check-ups, yearly or wellness exams, annual well woman exams, or preventive visits.

What is a Problem/Diagnostic Visit?

Problem or diagnostic visits are appointments that focus on new or existing conditions and include a thorough work up and treatment plan.

Can I have a Preventative Visit and Problem Visit at the same time?

Unfortunately, no. Billing issues prevent your physician from doing a Preventative visit and a Problem visit on the same day. This is for your protection as your insurance carrier may deny one of these visits which would then make you financially responsible for the visit. We ask that you please schedule a separate appointment, on a different day, for your preventative visit and for any new concerns or ongoing health problems that need attention.

Will my insurance pay for a Preventative/Wellness Visit?

Most health plans will pay for one Preventative/Wellness visit per year. Your insurance provider may consider this to be once per calendar year or one year and one day since the date of your last Wellness exam. If you have had any other visit billed as preventative during this time period then your plan is likely to deny your Wellness visit. This would include a well-woman exam or annual pap smear. It is the patient’s responsibility to check with their insurance provider to see what is covered under their wellness benefit and to ensure they are eligible prior to scheduling their annual Preventative/Wellness exam.

Brook Schales, ND, PLLC | Naturopathic Family Physician