Navigating your preventive health insurance coverage can be a challenge. Here are three things to be aware of.

Annual Physicals vs. Routine Medical Care

An annual physical is a service focused on preventive care and health maintenance. It's tailored to you based on your age and other risk factors, so potential health problems can be found early, when they may be easier to treat or prevent. During your physical exam, your doctor may perform or order screening tests for conditions such as cancer, high cholesterol or diabetes. They may also give you recommended immunizations. Many insurance companies cover these preventive services at 100%.

However, your physician must document and report some services to your insurance company as routine medical care. This applies if a new health problem is found that needs more evaluation and management, or if you need monitoring or treatment of an established condition during your physical. That part of your visit may be subject to a cost share based on your benefit plan, even if your physical is covered at 100%.

Laboratory and Other Tests

Insurance companies often cover 100% of certain screening tests ordered or performed during your preventive visit.

However, depending on your plan, you may have to pay for tests that diagnose or monitor an established or suspected condition.

Deductibles and Co-Insurance

Depending on your insurance plan benefits and the services you receive, you may be responsible for some or all of the charges for your visit through a co-pay, deductible or co-insurance.

Remember

• To maximize your benefits and avoid surprise charges, talk with your insurer before your visit to understand which screening services are covered.
• Ask your provider whether the tests or labs ordered during your visit are for screening or diagnostic purposes.
• If you have a medical condition that needs to be addressed, there may be a cost for treating that condition.
• Learn the details of your insurance plan, and talk through any concerns with your insurance company and your provider's office staff.

Questions?

Call Patient Financial Services Customer Service at 802-847-8000 or 800-639-2719.