T. L. Jenkins M.D., P.A. complies with insurance coding guidelines from the American Medical Association (AMA). At your visit today your physician will provide a medical service and will submit codes to your insurance company according to the guidelines mandated by the AMA. We wish to share with you the difference between an “Annual Exam” and “Problem Visit”.
Please understand that our goal to give you the best medical care as well as making you aware of insurance guidelines with which we are also responsible.
Annual Exam (Well Woman Exam):
- An annual exam is preventive annual care without any medical problems
- Some insurance companies DO NOT require co-pay for an annual.
- In general, if you are in need of prescription or test for a medical problem or issue, this is considered by your insurance company and the AMA to be a “problem visit” and will be billed accordingly.
- If a problem such as a breast lump is found at your “annual exam”, the exam is no longer considered by the AMA guidelines as an annual exam. Both of these examples are problem visits and will be coded accordingly.
Problem Visit (I.e.: irregular or heavy cycles, painful intercourse, urinary problems, etc.):
- If you are having any problems that you need to address with your doctor during this visit feel free to do so. However, your visit must be coded as a “problem visit”, and will be billed in addition to your well woman exam. All codes and diagnosis are generated by your physician at the time of service in accordance with national standards set by the AMA. Most insurance companies DO require a payment for this visit.
- If you are in need of a prescription or test for a medical problem or issue, this is considered by your insurance company to be a “problem visit” and will be charged separately.
If you have any questions or concerns regarding this notification, please discuss it with our front desk prior to being brought back to an exam room.