Health Advocacy: Your Yearly Physical

Call it what you will: a physical, a check-up, or a wellness exam. If you've got health insurance, your plan is required to cover one wellness visit per year. The trick about these physical exams is that their scope is very limited - if you refill a prescription or ask your doctor a detailed diagnostic question, it may be billed as a different type of visit, resulting in a hefty medical bill in your mailbox. Let's talk about the do's and don'ts of your annual check-up.

Even if you feel healthy as a horse, you should still go to your annual wellness exam. This is the one time of year you have to talk to your doctor face-to-face about any of your health concerns. You will likely also be able to get some preventative labwork done, and it is always good to have records of how your health changes over time.

Note: if you don't have health insurance, visit Connect for Colorado today to get yourself signed up on a plan and avoiding that tax penalty! Even the most minimal (aka "catastrophe") coverage is imperative to have - if you are in a serious accident you do not want to go bankrupt because you never signed up for "health insurance!

Before You Go

• Schedule your visit.
  • For a physical exam, you will often be scheduled with a Physician's Assistant or Nurse Practitioner. It is your right to ask to schedule with your doctor instead of one of their supporting practitioners.
  • If you want to see your doctor, I recommend that you book your appointment over the phone.
• As with any medical visit, it is imperative to call your insurance company before your visit.
  • Ask your representative what is covered in a physical and what isn't.
  • Ask what labwork is considered preventative and then repeat back what you heard. "Just to be sure I am correct, a lipid panel and A1C testing are considered preventative and will be free, as in, at no cost to me?"
  • The representative will likely ask you if you have a specific question for your doctor. Any questions you have for your doctor are your Protected Health Information, no phone representative has a right to ask you about them. Do not tell the representative anything about your reasons for booking your appointment. They are there to answer you logistical questions, not talk about your health care.
  • Write down the name of the representative you spoke with, the time you spoke, and the answers to all questions. If you are unfamiliar with the name of a lab or procedure, ask them to spell it for you.
• Prepare your list of questions
  • Remember, your doctor has limited time to spend with you. The doctor already has a script prepared of how this conversation will go. If you have questions, you may find yourself leaving the office without answers, as you never had a moment to ask them, or they slipped your mind.
  • Write down any questions you have about your health. Include questions about your diet, exercise level, any pain present, new bodily or psychoemotional concerns, etc.
• Go to the lab and have any preventative bloodwork done at least 5-7 days before your visit.
  • At the lab, ensure that the only labs being run are the ones you were told were preventative.
  • Bring your written list of preventative labs (from your phone conversation), and check these against what the lab is ordering. Be aware that you will be billed for anything outside of this list.
  • Do this a few days before your visit so that your doctor will be ready to review your results with you.

At Your Visit

• Bring your list of questions!
• Arrive 20 minutes early.
  • Yes, doctors often run late. But if you want your questions answered, you have to pull your weight and respect the doctor's time. If you are late, the doctor will be more likely to cut you off and not let you finish your questions.
• Tell your doctor that you have some things you'd like to discuss, after they finish the regular exam process.
  • Let your doctor go through the normal steps of a wellness exam.
• After your doctor has finished, tell your doctor that you have a few questions, and are hoping you can discuss them without being assessed a fee for an office visit.
  • Most doctors are compassionate to this, assuming you do not need a prescription and your condition does not require additional care. If your doctor is not compassionate, I recommend you select a new doctor for the future.
  • Ask your doctor if what you talk about can be left out of your medical chart.
    • This is because the person coding whether your visit is billable will be making their decision based on what is written in your chart.
    • Remember, it is always your right to make this request, and it is your doctor's right to decline your request.
  • Go through your list of questions with your provider. Write down the answers you receive.
  • Ask your doctor if they are documenting this conversation in your chart. If so, ask them if this will likely be billed as an office visit.
• Thank your doctor for their time and care. Establishing a good relationship with your provider is key to ensuring their support with your health goals.

After Your Visit

• Keep your eyes peeled on your mailbox/inbox.
• If you receive any medical bills for services provided, compare these bills to the list of preventative services which you wrote down during your pre-visit phone call with a representative from your insurance company.
  • If you have been incorrectly billed for a test that was preventative (e.g. labwork), read here for information on how to settle the dispute.
    • Do not pay any medical bills if you are not sure if they are correct. Call your insurance company.
  • Remember: the person who codes whether your visit is billable or preventative is usually not your provider. This person looks at your chart and decides whether or not to assess your visit as a wellness exam or a billable visit. This person works in the coding department. As this person has never worked with you and does not know your case, this person is more likely to make mistakes. This person's entire job is to assess how the insurance company can collect money - many people are incorrectly overbilled for preventative services, particularly bloodwork!

Bottom Line: The Trick to Wellness Exams

If you have a specific question for your doctor, or a particular reason for scheduling this physical exam, it may end up being billed as an "office visit," rather than a "wellness visit," and you may be assessed a bill of upwards of $100. Talk to your doctor like the human being that they are. Let them do their job (documenting the necessary information for a wellness exam), and then tell them your goal is to not be billed for an office visit. If your condition requires additional care, be aware that you may be billed for an office visit. Always double check your medical bills before you pay them to ensure no errors were made. If you have any questions about how to handle your physical, contact me, I am always happy to help you prepare for your visit and assess your bills.