Preventive visits are a critical piece of long term health care. Prevention and early detection through check-ups, screening and education align with Specialty Natural Medicines goals for your best health. Preventive visits are also a great opportunity for you and your Doctor to have time dedicated to discussing, documenting and updating your overall wellness.
However, how annual preventive visits are defined by insurance companies can be confusing to patients. Many patients believe that they get to bill any visit (once a year) to their Doctor as “preventive” and avoid having to pay co-pays, co-insurance or a deductible office visit.
The actual rules for what meets the definition of a “preventive” visit is actually quite different. Preventive is specifically in relation to early detection of illness, disease or identification of risk concerns with your Doctor. The visit is to have counseling time with your Doctor to discuss ways to prevent serious health issues.
One great test to determine if your visit is preventative is whether or not you have a “chief complaint”. If you have a specific health complaint or concern it is not a preventive visit. For example, if you come in to see your doctor with a concern about back pain then your insurance company will consider it an office visit and not a preventive visit even if it is your first (or only) visit to the Doctor that year. Pretty much anytime you come in because of a specific symptom or condition, the visit must be billed as an “office visit” and is subject to co-pays, co-insurance or deductibles as defined by your health insurance plan.
There are specific health concerns that may qualify as preventative based on your risk factors.
View the list of visits that could be classified as preventative under the ACA at HealthCare.gov. Your own benefits may vary under your specific insurance plan.