An Annual Wellness Visit is a yearly visit with a primary care provider to prepare or update a personal medical plan. The purpose of these visits are to identify potential health problems in the early stages when they may be easier and more effective to treat. This preventative exam is “prevention focused” and not “problem focused”.
Healthcare billing rules and regulations are challenging and complicated. This is especially true when it comes to understanding the benefits covered by your insurance carrier that are considered “preventative” vs “problem focused”. The goal is to identify potential health problems in the early stages of disease progression. Your annual exam may include the following:
Past medical, surgical, social and family history
- Complete physical examination and review of body systems (including Pap/HPV, breast exam and/or pelvic exam as indicated)
- Review of medications
- Age-appropriate immunizations review/recommendations
- Counseling and education regarding risk guidance and risk factor reduction interventions (i.e., Lowering cholesterol, tobacco cessation, healthy eating, etc.)
- Review and recommend age/gender appropriate screening tests (i.e., Colonoscopy, bone density, mammogram, etc.)
- Basic laboratory exams (this is plan specific so be sure to check with your insurance to confirm which tests are covered)
This preventative examination may identify problems that require treatment (i.e. depression, high blood pressure, diabetes, etc.). In identifying those, through screening examinations, treatment may be discussed and necessary. Once it is an identified problem, it is no longer prevention/screening. Please understand that depending on the concern, if it falls outside the scope of the routine preventive exam, there may be a problem focused exam/testing related charge submitted to the insurance. These will be subject to your plans benefit determination. At River Family Health, we strive to provide the best possible care to all of our patients – your health is our number one concern.