My insurance plan covers Preventive and Physical Examinations. Why did I receive a bill for services provided during this visit?
The “preventive or wellness” code includes your medical history and other questions related to your overall health and wellbeing. It is a service to evaluate and maintain your health and is focused on preventing future illness. It includes a stable or chronic condition(s) that requires no additional work-up or treatment modification.
The “problem-oriented examination” is related to the history of a specific problem or illness, and medical care focused on assessing and treating the problem or illness.
However, during your visit the physician may need to work-up and/or treat a new condition or make treatment modifications for an established condition that want reviewed.
When this occurs, Sansum Clinic is legally required to submit a bill to your insurance company that most accurately describes all the services that were provided. As a result, the charges for a visit that include both a “preventive” and a “problem-oriented” service must be broken into two distinct codes.
This may result in an additional charge for the visit that you thought was going to be covered with no deductible or coinsurance/copay by your insurance company.
Coverage is based on a member’s individual health benefits and may vary from payer to payer. We advise you to call your insurance company to confirm your benefits for prior to your appointment.