Oak Hills Womens Center

Annual Exam or Problem Visit?

Have you ever scheduled an annual exam and thought that would be a great time to also tell the doctor about some problems you are having? Although convenient for the patient, because of time demands and insurance denials, most physicians recommend the two types of visits (annual and problem) be scheduled on different days.

By definition, an annual exam, or “preventive” or “well woman” exam, is a routine check-up which includes the following:

  • Updating of the patient medical history
  • Blood pressure and weight recordings
  • Breast exam and pelvic exam with Pap smear, as indicated
  • Ordering of preventative tests, such as mammograms and bone density testing
  • Routine screening lab work and routine medication refills.

It does not include discussion and management of new problems or detailed review of chronic conditions. It is strictly a preventative visit.

On the other hand, a problem visit is a consultation which focuses on discovering and evaluating problems, such as abnormal bleeding, pelvic pain, urinary symptoms, etc. In most cases, physicians recommend addressing the medical issues first in a problem visit and scheduling the annual exam for a later date.

By their very nature, doctors want to treat patients completely, but often their hands are tied by insurance companies’ rules and payment policies. Although a few insurances will cover two types of office visits in one day, (while assessing a patient co-pay for the problem part of the visit), most of them bundle the services, deny payment, and shift the responsibility to the patient for payment. When this occurs, nobody is happy except the insurance company. The patient didn’t expect to have to pay for the visit, and the doctor didn’t get to provide the services that the patient needed, or was denied payment. Also, when a doctor tries to accommodate the patient and provide two services in one day, the visit tends to run longer than scheduled for, making the doctor fall even further behind in seeing patients. It’s a real dilemma for all concerned.

Please consider these recommendations:

  • If it is time for your annual exam, but you are having problems, schedule the problem visit first. The annual exam can be scheduled after the problem is managed.
  • Do not expect problems to be evaluated at an annual exam.
  • Realize that your physician may discover problems at the annual exam, and elect to begin evaluation of them. It is up to the physician to decide if two billing codes are warranted at that one visit, even if a patient co-pay applies. You may advise the physician and staff if you do not want any problems addressed at the time of the annual exam. In that case, a follow-up visit would have to be scheduled.
  • If you have Medicare coverage, be aware that Medicare will cover an Annual Wellness Exam, which is different from a preventive visit. This should be scheduled with your primary care provider (usually Family Practice or Internal Medicine)

Lastly, patients should not overlook the importance of preventive office visits. It is through this type of visit that many medical problems are identified, long before symptoms are present. Take care of yourself first—you’ll be glad in the long run that you did!

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