At first a preventive visit and office visit may seem similar, but there is a difference. Knowing which to schedule can help ease any confusion.
You schedule preventive visits which are annual physicals, well child exams and wellness exams to help prevent or detect any health concerns. This is also known as your annual wellness exam or annual health maintenance exam. Confusion comes when at your annual checkup you want to discuss or receive treatment for a new or existing condition that requires action. This is where a preventive visit can become an office visit and your bill can be impacted.
You schedule an office visit, or problem-related service, for problem focused care, meaning you notice symptoms and want to talk with your provider. In your preventive visit if a problem is addressed and needs to be treated, your provider’s office is required to bill as a separate office visit, due to action for treatment needed.
What is a preventive visit?
- Complete physical exam (annual health maintenance exam)
- Blood pressure, blood glucose and cholesterol screening tests
- Pelvic exams, pap smear
- Mammograms
- Prostate and colorectal cancer screenings
- Sexually transmitted infection testing
- Thorough review of medical history, general health and well-being
- Vaccination review and update
- Developmental screenings
- Evaluation of future risks
What is an office visit?
- Diagnosing and monitoring specific medical conditions
- Addressing medical concerns and treatment plans
- Post hospitalization discharge care
- Medication refills
- Specialist referrals
- Testing/lab results
- Addressing new or worsening symptoms
- Depending on benefits an office visit can result in additional costs
Before scheduling an appointment state clearly whether this will be a wellness exam or if this appointment will be to discuss and treat new health concerns or symptoms. If a wellness exam is spent on specific or new health issues and treated it will no longer be considered a preventive visit, and it will be billed as an office visit.
