Understanding Your Visit
If you’re confused about the different visit types you’re not alone. What you pay out of your pocket for these services has also changed. Deductibles and co-pays vary depending on the type of insurance you have.
We want to help you understand the different types of office visits we offer so you know what to expect. Here are some descriptions as well as what insurance may or may not cover. These are general guidelines only. Your insurance company’s coverage might be different, and it’s important to know your benefits prior to scheduling an appointment. We encourage you to familiarize yourself with what your insurance plan offers. Visit your insurance company’s website or call them for details.
An exam on a healthy person with no symptoms to look for hidden disease and give advice on healthy behavior. Getting the right preventive services at the right time can help you stay healthy by preventing disease or by detecting a health problem at an early stage when it may be easier to treat.
- Does Not Include: Evaluation of new symptoms, or management of chronic problems.
- Insurance Coverage: Covered by most insurances, however if new medical issues are discussed or chronic problems are managed there may be an additional office visit charge. Check your policy for frequency limitations.
A visit to review chronic problems, adjust medications, check laboratory monitoring, or refill prescriptions. For some simple chronic problems (e.g., allergies), this may be once a year. For more significant problems, it may be at least twice a year.
Also can be an appointment to investigate a new symptom—such as chest pain, weight loss, or depression. Oftentimes, the problem may be quite complex, with multiple symptoms that require diagnostic tests and follow-up office visits.
- Does Not Include: Review of preventive services.
- Insurance Coverage: Covered by almost all insurance, including Medicare and Medicaid. Co-pays and deductibles may be applied. Check your policy for exclusions (non-covered services)
“Welcome to Medicare” and Annual Medicare Wellness Visit
Specialized planning visit to review which Medicare preventive services you need. Medicare requires that a standard set of questions be asked. They must include: review of functional status, depression screening, list of special medical equipment (if any), and list of other doctors.
- Does Not Include: Medication refills or evaluation of new symptoms.
- Insurance Coverage: Medicare pays in full. There is no co-pay or deductible.
Other Types of Examinations
Camp physicals, school physicals, work physicals, insurance physicals—this type of visit requires the doctor to fill out a form. Services include whatever is necessary to fill out the form.
- Does Not Include: Medication refills or evaluation of new problems.
- Insurance Coverage: Sometimes covered by insurance, but often not. In cases where a form is needed a short time after an appointment (i.e., child had an annual Well Child Exam to update immunizations and three months later needs a form filled out for camp), the doctor may be able to complete the form without another visit. However, there is a fee to fill out the form and that fee is not covered by insurance.
At times for various reasons you may need a form to be filled out by the physician and signed. We request that you bring these forms with you to an appointment however we understand that you may have had a recent visit and we can use the information from that visit to fill out the form. This is still work for a medical provider. Some forms require detailed information deep within your patient record. We will do our best to make sure the form is filled out accurately and in a timely manner. Because of the work involved and staff time to process each form there is a fee to fill out forms.
Coding for Your Insurance
The difference between medical services is sometimes hard to understand. As a physician practice, Mansfield Family Practice does not control these differences. Our reimbursement is based on the coding system that insurance companies use to describe medical work. For example the coding system classifies a physical exam and medication refill as two separate services. Think of it this way: you wouldn’t expect a plumber come to fix a leaky sink and install a dishwasher for no extra charge. The same is true for medical services.
Can I combine services?
For your convenience, the provider may combine two types of services at one visit — a Wellness Exam and an office visit to refill blood pressure medication, for example. Many factors determine if we are able to do this at a particular visit, how well a medical condition is under control, a new more urgent problem is present and the general health of the patient is all a consideration. However, because these are two different services, there would be two separate charges to your insurance company. You may need to pay a co-pay or satisfy more of your deductible.
How do you decide what to focus on during an exam?
Providers are taught to examine thousands of physical signs—from knee reflexes to heart sounds. When conducting an exam, the doctor relies on your personal medical history in combination with any current symptoms or problems. Sometimes, specific symptoms such as a heart murmur or rash will be the actual diagnosis.
How do you decide what tests and services I should have?
Providers are specially trained to evaluate the usefulness of tests and preventive services and help you decide which ones are right for you. We offer advice on immunizations, X- rays, blood tests, and a host of other special procedures. Generally, testing is based on your age, health history, and risk factors. We rely on information from the United States Preventive Services Task Force to guide our recommendations.
What is a Co-Pay?
A co-pay is a fixed amount you pay for a covered health care service when you get the service. The amount can vary by the type of covered health care service. If your insurance plan requires co-pays Mansfield Family Practice is supposed to collect the co-pays at the time of service.
What is a Deductible?
The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
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