Frequently Asked Questions
Friday, December 30, 2016 11:16 PM
What is a Wellness Visit / Complete Physical?
A Complete Physical is a Wellness Visit. This is not a visit to save up a list of problems, it is a visit to review your health history, issues that run in the family, and address preventive health care. It's a chance to identify risks based on lifestyle, genetics and exposures and to try and prevent the bad things. We will review health issues that place you at risk of injury or cancer. This includes a comprehensive examination based on needs, and for women it includes a breast exam and pap if due, for men it may involve a prostate exam.
This is when we make sure you are up to date on immunizations, colonoscopies, mammograms, bone density, and more.
You'll then have laboratory evaluation for cell counts, liver and kidney function, electrolytes, diabetes, cholesterol and more depending on what is discovered.
It does not include medical treatment for specific health conditions, on-going care, lab or other tests necessary to manage or treat medical issues or health condition considered diagnostic care or treatment that is not preventive. If these are done during a physical it may have to be coded separate from from a physical.
Is a Complete Physical covered by insurance?
Most insurance companies cover Wellness Exams / Physicals. Preventive care saves lives and saves money, so it is in the best interest of everyone to have a yearly visit. Plans under the Affordable Care Act, Medicare, Healthspring and Cigna value the importance of Physicals and strongly encourage that they are done. There is usually no copay or cost involved with physicals under these plans.
Other insurance plans, private insurance and company plans may or may not cover physicals and it's your responsibility to check with your insurance company for your specific coverage. Whether covered or not, it's a good idea to have this service yearly. It's like saving for retirement, a little expense up front can save a fortune in the future.
I came in for a visit and need a follow up visit, do I have to pay another copay or charge?
Short answer, generally Yes.
Long answer: If you came in for complex problems or have multiple issues that cannot all be solved at one visit, you may need to come back for a follow up visit. Examples:
1. Blood pressure follow up and your pressure is not meeting goals yet, we may need to adjust your medication and recheck the response in days or weeks.
2. An appointment is made for one thing, but a heart murmur, or suspicious mole is found, or when you come in you have multiple complaints and we have to prioritize the compaints and deal with the most serious first, you may need to come back for a follow up visit to address the rest. It is not practical or wise to try and address every issue in the limited time afforded.
In these cases, a follow up visit is a separate appointment and yes, there is a charge or copay for this. There is a misperception that physicians are paid a global fee that is supposed to cover everyting in one visit. Fact is, the payment for a 15 minute appointment varies very little from a 30 minute appointment and reimbursement is not per problem. There is no reimbursement for all the behind the scenes activity, gathering results, contacting specialists, filling out insurance forms, long phone calls with insurance companies for authorization, or telephone or web questions. All these things cost money however.
We do our best to resolve issues efficiently, but your safety comes first and there are general guidelines for proper care that must be followed in managing medical problems. Deviating from standard guidelines places you at risk for complications and dramatically increases our malpractice risk. Failure to follow up for a medical issue as recommended places you at high risk and demonstrates medical non-compliance with your insurance company. For example, not following up on blood pressure management increases risk of heart disease, heart failure, kidney damage, stroke, and more.
There are a few exceptions that do not require payment for follow up, usually procedures. Skin excisions or sutures do not have a charge to come back and check the wound to remove the stitches. These procedures have a "Global Period" where the initial fee covers the follow up. Other examples would be surgeries like General or Orthopedic. The surgeon is paid a global fee to cover the surgery and any complications after the surgery.
Why do I need to be seen every 3-6 months for __?
This is a frequent discussion and disagreement. Certain medical problems like Hypertension or Thyroid issues are followed at least every 6 months for safety. These medications require monitoring for side effects and effectiveness. You cannot assume that your thyroid medication does not need dose adjustment. Over medicating can damage the heart, bones and other organs. Uncontrolled blood pressure can cause kidney failure, heart disease, strokes and more. Changes in diet, weight and aging will dramatically change how well your medication works.
Diabetes uncontrolled is monitored at least every 3 months, while controlled diabetes can be every 6 months. Adjusting medications that manage diabetes may require more frequent visits. This is just good medical practice.
Other issues involve controlled drugs that have specific DEA requirements for follow up. These include pain medications, ADD medications and anxiety treatments.