Dr. Andy Fine explains, a physical is defined by both, insurance companies and the government, as Preventive Care Only!
We see people that come for a physical, but also want to address other concerns ranging from a hangnail or wart, to shortness of breath or chest pain, to diabetes etc … these additional issues are not necessarily considered preventive care. Therefore, they may constitute a separate billable code for the non-preventive part of the visit.
Insurance companies encourage physicians to just stick with a visit for preventive care. This will include the physical and, potentially discussing diet and exercise, moving sensation, colon and various other cancer screenings, lab work and other things that have proven to be effective at screening. These various tests/discussions screen for conditions the patient is not aware of and has no symptoms, but can be serious medical health concerns needing to be addressed.
A lot of patients come in just when they need a refill or a treatment of acute symptoms. Unfortunately, they continue to ignore getting a preventive visit. If they aren’t getting other things checked out, evaluated or screened for, they may run into problems that could have been easily preventable sooner than later.
Patients should be evaluated yearly for preventive care, regardless of age. It should be separate from their acute symptom appointments. Preventive care is covered and paid for by the government and/or the insurance company, and for good reason. It is because they have found it to be effective to be done yearly.
One important aspect of physicals that might encourage some people to follow up with getting them… they are 100% covered* – no out-of-pocket cost to the patient! It’s the law. There is no deductible, no co-pay, no percentage that will have to be paid for that visit. It is totally covered.
*Keeping in mind, labs MAY NOT be considered preventive. While the physicians services are covered at 100%, many insurances, including Medicare, DO NOT PAY for lab services as a screening exam. They will charge the patient.