The Wellness Visit: For those with Affordable Care Act or ACA approved health insurance (aka Obamacare) – either through an employer or purchased on your own, a covered wellness exam is part of the package. These wellness exams cover a host of preventative tests, screenings, and treatments including immunizations, mammograms, cholesterol/blood screening, blood pressure screening, smoking cessation, etc. Here is the covered Preventative List from Kaiser Permanente. The list is quite extensive. Consult your insurance carrier for a full list of covered Wellness services.
Scheduling: When scheduling the Wellness Exam, you need to use the proper terminology to be sure the items will be covered at no cost to you.
- Ensure that your doctor is “contracted and in network” with your health insurance. Contracted is the key word because networks are constantly changing. You also need to know the complete name of your plan – i.e. Anthem Pathway HMO or United Healthcare Choice Plus. The insurance companies offer many different plans, and asking the doctors office, “Do you take Anthem?” could cause problems – they may not be contracted with your specific plan. A simple phone call to the doctors office asking, “Is Dr. (name of doctor) “contracted” with (complete name of plan)?” If the doctor is not contracted, you will likely pay for the entire visit yourself.
- Now that you know your doctor is contracted with your plan, schedule the wellness exam by saying something like, “I would like to schedule my annual wellness exam, and I would like it to include . . . (a cholesterol screening, a PAP smear, a mammogram, and any immunizations that are due).” Consult the list above for any additional screenings or services that you want included in your visit.
What is NOT covered?: Unfortunately, gone are the days of visiting your doctor with a complete list of aches, pains and concerns. The Wellness Visit follows a list of covered procedures. Be sure to know which screenings you want included in your exam. If you ask about the ache in your knee or your sore throat, that will be coded separately and you will be charged based on the details of your plan.
Get Scheduled: The goal of the Wellness Exam is to create your baseline. Those results can be compared annually to recognize any health changes that could point to a problem. When treating illness, early detection is important.
Certainly, you can reach out to us if you have questions about your plan.