Most insurance companies cover one Preventative Exam each calendar year. The type of services covered depends on the type of insurance you provide. It is the patient’s responsibility to know their insurance benefits prior to their appointment. As a courtesy, our office will ensure your provided insurance is active, will notify you of any known out of pocket at check-in and will file claims with your insurance.
Commercial Payers will typically cover the following:
- Complete physical examination
- Gynecological / Breast Exam for females and Prostate Exam for males
- Skin Survey
- Appropriate age-related diagnostic testing (basic lab work, pap smear, mammogram, colonoscopies, DEXA scan)
Review, scheduling, and administration of age-appropriate immunizations.
Medicare will typically cover the following:
- IPPE – Covered during the first year of Medicare Coverage
- Annual Wellness Visit – Covered annually while insured by Medicare
- Gynecological / Breast Exam for females and Prostate Exam for males
- Skin Survey
- Appropriate age-related diagnostic testing (basic lab work, pap smear, mammogram, colonoscopies, DEXA scan)
- Review, scheduling, and administration of age-appropriate immunizations (Flu, Pneumonia, COVID, and Hepatitis B vaccines are the only vaccines covered by Medicare Part B).
Services non covered by the Preventative Visit are subject to your co-pay or deductible and include (but not limited to) the following:
- Office Visits for illness, chronic or acute conditions or medication refills.
- Minor in office procedures (cryo therapy, mole removals, joint injections, IUD placement)
- In office medication administration or testing
- Lab work not preventative in nature
If time allows, the provider may consider adding additional services to the visit (ex- refilling medications). If multiple services are performed at your preventative visit, your insurance will have both preventative and non-preventative codes billed for the same date of service. This may lead to an out-of-pocket expense for the guarantor. Please sign below stating receipt of this notice. For questions, please speak to the front desk staff or Billing Manager prior to your visit.