Types of office visits
Understanding the difference between a Health Maintenance Visit and an Office Visit can help determine the type of visit to schedule.
- Health Maintenance Visit – a “preventive care” visit, often referred to as a routine exam, annual physical, well-visit, or yearly check-up. This visit with your provider does not include any tests or treatments for medical issues.
- Office Visit – a visit to check on a specific issue or concern. This visit could include an ongoing health issue. During this visit, your provider may have you schedule additional tests or recommend treatment.
Frequently asked questions
Is it possible to have both services at the same time?
Yes. If you are scheduled for a health maintenance exam, your provider may still want to discuss any other symptoms or problems you have. This will help to identify minor issues before they become too serious.
Sometimes there isn’t enough time to talk about all of your symptoms; in that case, the provider will ask you to come back for an office visit. If you are treated for a medical issue during a health maintenance exam, we must bill your insurance plan for both services. This is a rule set forth by insurance companies.
If I receive both services, what are my out-of-pocket costs?
You will be responsible for any services your plan does not cover.
What should I ask my insurance company?
To help you determine what your total costs will be, please get in touch with your insurance company to look into your specific plan.
- What does my plan cover?
Will an office visit be covered? How much will I end up paying for testing or treatment of a particular medical condition?
- How much will I need to pay?
What are the co-pays, deductibles, co-insurance responsibilities, and other out-of-pocket costs?
- Are there limits as to what my plan pays for?
Are there limits to my plan’s number of health maintenance exams, office visits, and routine tests?
- Does my plan cover lab work?
Your provider may order labs based on new or pre-existing conditions. Your coverage will be determined based on your individual coverage.
Important information about Medicare
Your provider may recommend you get more services more often than Medicare covers or may recommend services that Medicare does not cover. If this happens, you may have to pay some or all of the costs. Remember to ask why your provider recommends certain services and whether Medicare will pay for them.
Find more information at www.cms.gov.