Differences Between Preventive Health Visit and Office Visit

What is included in a “preventive health visit?”

A preventive health visit is an annual physical with your provider that focuses on overall health. During this type of visit, your provider will look at your health risks and talk with you about family medical history, past illnesses and surgeries, risks you may have for specific conditions, and how to maintain a healthy lifestyle. Your provider will check your weight, height, temperature, blood pressure, and pulse. He/she will listen to your heart and lungs, and check your ears, throat, skin and abdomen. Typically, your health insurance plan covers 100% of a preventive health visit when you see a provider in your plan network.

What about lab tests for disease screening and immunizations?

Most health insurance plans cover certain screening tests (such as mammography, colonoscopy, and cardiovascular disease screening), as well as immunizations (such as influenza and COVID-19). HOWEVER, in some cases, you may be responsible for a co-pay or deductible payment. Specific coverage of screenings depends upon your age and health insurance plan. If you are unsure, we strongly encourage you to contact your health insurance company.

What is included in an “office visit?”

The purpose of an “office visit” is to discuss, evaluate, and treat a SPECIFIC health concern or condition or chronic problem that has changed. This type of visit may include lab work, X-rays or additional tests related to your health concern. Because this type of visit is addressing a specific problem, it is coded and billed differently than a “preventive health visit” and could result in a separate bill. If you schedule a preventive health visit and a SPECIFIC health concern is evaluated during this visit, your provider’s office will code and additionally bill this appointment as an “office visit.”

HERE’S AN EXAMPLE: A patient comes in for an annual physical and mentions during the appointment that he/she is having knee pain. The provider may perform additional exam elements related specifically to the knee pain. The provider might also order X-rays and counsel the patient on next steps, conservative measures, and possible treatment options. In this case, the patient would be billed for a preventive health visit for the annual physical AND would be additionally billed for an “office visit” for evaluation and treatment of knee pain.

We strive to provide the highest quality of care and to do so, we must be reimbursed for all the care we provide. It is important that you understand your health insurance benefits. If you need further clarification, we encourage you to contact your health insurance company or call our Billing Office at 857-282-2300. We appreciate you choosing MRPG for your care.

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