Your Annual Physical is Important

Since we are not sure what will happen to the Affordable Care Act (aka Obamacare) we have set up in the United States it might be a good idea to get your preventative services now. Schedule an appointment with your primary care provider as soon as possible if you have not had one in the past year. This way if the insurance structure changes you have at least had the chance to be seen for your preventative services that are currently being covered.

When talking of preventative services I mean that well woman or man visit, also known as an annual physical. A Medicare Wellness Visit is a different entity which I won’t be covered in this blog. When you make your appointment there are a few things you should consider. First, this is for prevention. This is not a visit to cover illnesses or concerns. If you have issues like a new pain, a rash or other problems that need an evaluation and diagnosis, this is not usually covered in a preventative service visit and will be discussed more in a moment.

Prevention means we are trying to prevent illness. These visits are to screen you for possible issues that your provider can address to keep you from illnesses. A pap smear is done to screen for changes in the cervix that may lead to cervical cancer. Having a colonoscopy may find a polyp that can be removed before it becomes cancerous. A flu shot is given to lessen the symptoms of influenza if you get it or possibly prevent it all together. Your provider will review your information and take an individual approach for you based on your risk factors to consider things like cholesterol testing and checking for diabetes.

Each visit will include vital signs to check for hypertension and obesity. Counseling on weight, diet, exercise, sun screen, going to an eye doctor and dentist may also be included. These are all things that will help you stay (or become) healthy and also will help you determine if you have an issue that can be addressed sooner than later when it could become something worse. Not every provider will counsel on the same things. I tend to include things like wearing your seatbelt, sunscreen, home skin checks, and texting while driving while other providers may not. It is all individualized but is all geared towards keeping you healthy.

This all said, it is still preventative. If you come in with a concern (or a list of concerns), then we are changing the dynamic of the visit from screening to diagnostic. At that time you also change how the provider may document and code for the visit. If you have an issue that requires further work up that would normally not be done during a preventative service, this will lengthen the visit and also requires your provider to change her documentation. With this, your insurance will see that you were there for more than your preventative services and you will possibly receive a bill for the other services rendered. Under the Affordable Care Act all preventative services are supposed to be covered without a copay.

If you have questions you want to bring up, you can ask the clinical staff as they bring you back in to the room or ask the provider if she will address something. Starting an open dialogue with your provider about what you want out of the visit from the very beginning is important. Sometimes, if it is something like a mole that has changed, this would be considered a typical preventative service (to check for skin cancer). If you have developed something like chest pain, that would not be considered a preventative service (the provider has to ask you lots of extra questions, possibly do some tests, and work out a differential diagnosis of your condition which is way more than can be expected at a preventative service visit). So in some cases, she may decide to postpone the preventative service to address your concern. In that case, she should explain this to you. Also, there is the chance that if your issue is something that can be addressed later she may ask you to make another appointment to address it. Do not expect it to be addressed. If it is addressed and considered outside the realm of prevention, you may receive a bill so have that discussion this with your provider at the visit. It may save you much frustration later.

I consider this similar to going to get your oil changed/car maintenance. If you went in and just had the routine maintenance performed, the time taken is a certain amount and you pay for that. If you add a noise you have been hearing to this service, it will take more time, it will cost more money, and it will not be expected as something they would have normally done with normal car maintenance. If you ask for more services than you scheduled with your provider, expect a similar outcome.

Another aspect of the visit to consider is the time of your arrival. If the scheduler asks you to show up early, please do. Even if they do not ask you to come early, try to be a few minutes early. I don’t know how many times I have waited for patients to be brought back because they show up late, then I am also behind. This is one of many reasons why providers run late. So if you can be there early, the flow of your visit may improve. That is not a promise but I know in the offices I have worked at, this does help everyone.

Also, if you think you will need blood work or are requesting to have certain blood tests performed checking with your insurance can help. The same goes for immunizations. All insurances will cover for influenza in the doctor’s office but not all of them will cover a tetanus shot or shingles shot. Sometimes you will be required to go to a pharmacy to have the immunization. Knowing this in advance may save you time and money in the future.

Being educated about your insurance and your health care is very important for all of us. Learning how to navigate the system can be difficult but I hope this helps.