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Billing and Your Annual Exam

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IMPORTANT NOTICE FOR YOUR ANNUAL EXAM

Under the Affordable Care Act, and now consistent with all health insurance policies, your annual preventive medicine exam includes a very limited set of services. Annual exams may also be called “routine check-ups”, “yearly exams”, an “annual pap”, or “preventive visit”.

It is critical to know the difference between preventive and diagnostic services.

Preventive Care

Preventive care includes routine well exams, screenings, and immunizations intended to prevent or avoid illness or other health problems.

Diagnostic and Treatment Care

Diagnostic and treatment care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose/treat them.

YOU WILL BE CHARGED A COPAY/DEDUCTIBLE FOR ANY

DIAGNOSTIC AND TREATMENT SERVICE

  • Unfortunately, your insurance company does not include any diagnostic and treatment services in your annual / preventive exam.
  • Your insurance company may deny payment for your annual exam if another service is provided.
  • This does not prevent you from asking a simple question or requesting refills of any maintenance medications. However, if you have any new concerns (including new birth control) or other ongoing health problems that need more attention, this becomes a diagnostic and treatment visit.
  • When a wellness exam turns into a diagnostic or problem-oriented visit we must bill accordingly. Thus, it is best to reschedule a separate appointment on a different day if you are concerned about additional costs for additional services.
  • You may receive a bill from us for a deductible and / or a copay.

It is your responsibility to check with your insurance provider to see what is covered under the wellness benefit and to ensure eligibility prior to scheduling an annual wellness exam.

If you have any questions or concerns regarding your copayments / deductibles, we recommend that you call your insurance company to further explain your specific plan, covered benefits, and your financial responsibility.

None of the above is unique to Maiden Lane Medical. This occurs across the country. We always do our best to provide one-stop services and the best patient experience possible. This notice is intended to make you aware of your insurance coverage.