Is it Preventative Care or Medical Care?

With rise of high deductible health plans (HDHP) people have to pay more out of pocket for healthcare. Most insurances cover preventative visits without any deductible or co-pay, however there is a lot of confusion on what constitutes a Preventative or Medical visit.

We have attempted explain below the difference between Preventative and Medical Visit per insurance guidelines. Please remember, there may be exceptions to this guideline. If you have any questions, please call your insurance company.

New Patient Preventative Care Visit

  • (Also referred to New Patient Annual Physical)

  • It is for individuals WITHOUT any current medical problems (if you have medical problems it becomes a medical visit - see “New Patient Medical Visit below)

  • Involves a comprehensive review of past medical/surgical history, allergies and family & social history

  • Review of screening, counseling, and focused physical exam based on age, sex, and risk factors

  • Appropriate lab and imaging tests for screening and/or risk assessment

    • Please Note: We cannot order labs before a new patient preventative visit because we need to see you in the office to establish patient-provider relationship

  • It is NOT an assessment and treatment existing for new medical problems

  • Most insurances should cover the cost without copay/deductible. Please confirm with your insurance as your policy may be different and/or they may not cover all the services (e.g. lab or imaging tests)

New Patient Medical Care Visit

  • It is for individuals WITH existing or new medical problems

  • Involves comprehensive review of prior and current medical problems (including prior medical records), allergies, family & social history

  • Focused or comprehensive physical exam depending on medical problems

  • Assessment and treatment of medical problems

  • Copay or deductible applies

  • If you are on a high-deductible health plan, please call your insurance company to understand your out-of-pocket costs as it may be higher for the 1st visit


Combined Annual Preventative and Regular Medical Office Visit

If you have existing or a new medical problem, we will combine your Annual Preventative/Physical (or Medicare Annual Wellness Visit) with a regular medical office visit. Copay/Deductible applies for the medical part of the visit.

This applies for existing patients. For new patients, if you need a physical on the same day, please let us know before so we can allot sufficient time to do both visits on a single day.

Why are we doing this?

  • Annual Preventative/Physical (or Medicare Annual Wellness Visit) is for preventative care and not for assessment & treatment of existing or new medical problems

  • However, most people expect that their medical problems will be assessed & treated during this visit as they are already in the office

  • It will save you time as you may not have to come back for another office visit

Will I get a copay/deductible?

  • Yes, there is a co-pay/deductible for the regular medical office visit component

What if I don’t want to or cannot pay the copay/deductible today?

  • Please let us know and we will perform an Annual Preventative / Medicare Annual Wellness visit on the day of your appointment 

  • We will schedule a regular medical office visit for another day (you will have a co-pay/deductible on that day per your insurance policy)

(Your co-pay/deductible is set by your insurance company. We can not waive co-pay/deductible per regulations.)