January 06, 2017
Please know “physical exams” do not include any medical issues unique to you (high blood pressure, asthma, arthritis, high cholesterol, diabetes, anxiety, depression, etc.). Under insurance company billing rules, physical/wellness exams and treatment of your specific medical problems are two different services, even if both are performed during a single visit. Doctors are required to document and bill each separately, otherwise risk fraud charges from your insurance company.
What this means to you is that when you receive the Explanation of Benefits (EOB) from your insurance company, you may see two office visits listed. One will be zero copay (annual wellness physical), but the other will be billed as a routine office visit. Any amount not covered under the general physical/wellness exam is considered by insurance company policy as patient responsibility; the deductible or coinsurance is billed to the patient.
Our clinic finds these insurance policies to be misleading and confusing; they violate patient expectations for a “zero” copay annual physical visit that should include review of all health conditions and medication adjustments, yet to participate in network with your insurance carrier we are obligated to comply.