Preventive Care Visit

What is a Preventive Care Visit

Your Preventive Care Visit (Physical) includes a routine physical exam, immunizations and services such that have been defined by the Patient Protection and Affordable Care Act. For a growing number of health plans, insurance providers will no longer be able to charge a copay, deductible or coinsurance for preventive services. Please be aware that if you have other health issues, check with your insurance company about what preventive services are covered by your plan.

Copay or No Copay

“Hidden Copays” - Even if a preventive test or screen is fully paid by insurance, you may still have a copayment or co-insurance for the doctor’s office visit. That is, the preventive care is free, but the doctor’s visit is not. Your Preventive Care Visit, which includes a routine physical exam and immunizations does not require a copayment.

If you discuss symptoms of acute or chronic diseases at your Preventative Care Visit, it is considered “diagnostic” and you will most likely be required to pay a copayment. Example: Let’s say you make a doctor’s appointment specifically for a preventive service or test (Preventative Care Visit/Physical), but during the course of the visit you are treated for an unrelated problem, like the flu or changes in your diabetes medications. For this visit you would be required to pay the copayment for the office visit.

Maron and Rodrigues Medical Group’s Core Value:

Treating the whole person is a core value at our practice. We strive to address all of your concerns and properly investigate issues that arise during your visit. When patients come to see their health care providers for a Preventative Care Visit they should expect the possibility that both preventive care and acute problems may be addressed during the same visit. Because of this copayment may be charged.

Reasoning behind the changes in coverage:

Americans get only about half the preventive services recommended by their health care providers, according to a 2003 report in the New England Journal of Medicine. The consequences are significant: A 2007 study by the Partnership for Prevention found that more than 100,000 lives could be saved annually by increasing the use of just five services: aspirin to prevent heart disease, smoking cessation assistance, screenings for breast and colorectal cancers, and flu shots. One response by the United States Government is found in the Patient Protection and Affordable Care Act, passed on March 23, 2010. For a growing number of health plans, insurance providers will no longer be able to charge a copay, deductible or coinsurance for preventive services. Despite these new regulations, there remains a lot of ambiguity — and not just amongst consumers — about what qualifies as preventive care. Because of this confusion, we encourage you to check with your insurance company about what preventive services are covered. Complaints with copayments: The decision of a copayment vs non-copayment for a visit is not decided by Family Practice Group; these decisions are based federal laws and insurance regulations. Complaints of this nature should be addressed with your insurance company.

Preventive Services Covered Under the Affordable Care Act:

Here’s a good rule of thumb: “If you discuss symptoms at your physical or if your provider orders a test, it’s diagnostic and you’ll most likely pay a copayment. If you have no symptoms, it’s covered."