Your Visit

Understanding Your Visit

What is a:

• Wellness Exam
• Physical
• Check Up
• Medicare Visit
• Chronic Care Visit

Wellness exam, physical, chronic care visit. If you’re confused about the differences among these terms, you’re not alone. The services performed at each of these visits are distinct. And deductibles and co-pays vary depending on the type of insurance you have.

At Brown Road Family Medicine, our goal is to help you understand the different types of office visits we offer so you know what to expect. Here are descriptions of each one, as well as the services provided and what insurance may or may not cover. These are general guidelines only. Your insurance company’s coverage might be different, and it’s important to know your benefits prior to scheduling an appointment. We encourage you to familiarize yourself with what your insurance plan offers. Visit your insurance company’s website for details.

Services Provided:

Physical/Check Up

• Well Man or Well Woman Exam?
  An exam on a healthy person with no symptoms to look for hidden disease and give advice on healthy behavior. Getting the right preventive services at the right time can help you stay healthy by preventing disease or by detecting a health problem at an early stage when it may be easier to treat.
• Does Not Include:
  Medication refills, evaluation of new symptoms, or management of chronic problems.
• Insurance Coverage:?
  Covered by most insurance. Not covered by Medicare but may be covered by secondary insurance if Medicare patient has that.

Follow Up/Chronic Care Visit

• A visit to review chronic problems, adjust medications, check laboratory monitoring, or refill prescriptions. For some simple chronic problems (e.g., allergies), this may be once a year. For more significant problems, it may be at least twice a year.
• Does Not Include:
   Review of preventive services.
• Insurance Coverage: 
  Covered by almost all insurance, including Medicare.

“Welcome to Medicare” and Annual Medicare Wellness Visit

• Specialized planning visit to review which Medicare preventive services you need. Medicare requires that a standard set of questions be asked. They must include: review of functional status, depression screening, list of special medical equipment (if any), and list of other doctors.
• Does Not Include:
   Medication refills or evaluation of new symptoms.
• Insurance Coverage:
   Medicare pays in full. There is no co-pay or deductible.

New Problem/Symptom Visit

• An appointment to investigate a new symptom—such as chest pain, weight loss, or depression. Oftentimes, the problem may be quite complex, with multiple symptoms that require diagnostic tests and follow- up visits.
• Does Not Include:
   Medication refills for other problems or review of preventive services.
• Insurance Coverage:
   Covered by almost all insurance, including Medicare.

Administrative Physicals

• Camp physicals, school physicals, work physicals, insurance physicals—this type of visit requires the doctor to fill out a form. Services include whatever is necessary to fill out the form.
• Does Not Include:
   Medication refills or evaluation of new problems.
• Insurance Coverage:
   Sometimes covered by insurance, but often not. In cases where a form is needed a short time after an appointment (i.e., child had an annual Well Child Exam to update immunizations and three months later needs a form filled out for camp), the doctor may be able to complete the form without another visit. However, there is a fee to fill out the form and that fee is usually not covered by insurance.

Coding for Your Insurance

The difference between medical services is sometimes hard to understand. As a physician practice, BRFM does not control these differences. Our reimbursement is based on the coding system that insurance companies use to describe medical work. For example, the coding system classifies a physical exam and medication refill as two separate services. Think of it this way: you wouldn’t expect to make a restaurant reservation for three people, and then bring a fourth person for free. Or have a plumber come to fix a leaky sink and install a dishwasher for no extra charge. The same is true for medical services.

Frequently Asked Questions

Can I combine services?
For your convenience, the provider may combine two types of services at one visit — a Well Man Exam and a chronic care visit to refill blood pressure medication, for example. Many factors determine if we are able to do this at a particular visit, how well a medical condition is under control, a new more urgent problem is present, and the general health of the patient is all a consideration. However, because these are two different services, there would be two separate charges. We may collect two co-pays at the time of your visit and submit two charges depending on your insurance benefit.

How do you decide what to focus on during an exam?
Providers are taught to examine literally thousands of physical signs—from knee reflexes to heart sounds. When conducting an exam, the doctor relies on your personal medical history in combination with any current symptoms or problems. Sometimes, specific symptoms such as a heart murmur or rash will be the actual diagnosis. Your medical history is always the first important consideration.

How do you decide what tests and services I should have?
Providers are specially trained to evaluate the usefulness of tests and preventive services and help you decide which ones are right for you. We offer advice on immunizations, X- rays, blood tests, and a host of other special procedures. Generally, testing is based on your age, health history, and risk factors. We rely on information from the United States Preventive Services Task Force to guide our recommendations.