What will your insurance cover?

Many of our patients have health insurance plans that cover the cost (including co-pay) of a yearly preventive health care visit – commonly known as your annual physical. Not all insurance coverage is the same; you can find out more about your coverage by contacting your insurance company.

Generally, insurance companies cover a predetermined list of components that are considered part of your physical. For example, during your annual physical, you may expect that your provider will do the following:

  • Gather or update your comprehensive medical history
  • Outline plans for the reduction of risk factors
  • Provide interventions or counseling to improve overall health
  • Order appropriate laboratory/diagnostic procedures based on your personal medical conditions (these services may or may not be covered benefit with your physical, for example: ekg or urinalysis)
  • Order and/or administer appropriate immunizations
  • Manage minor health concerns
  • “Minor health concerns” include the following and other similar concerns:
    • Obtaining a refill for a prescription for chronic medications (allergy or birth control, for example)
    • Asking your provider to pay special attention to a skin lesion during your routine physical.

More specific health concerns may not be covered by your insurance as part of your yearly physical. These are concerns that would normally prompt you to schedule an appointment if you were not scheduled for your physical. If time permits, some of these concerns may be addressed at the time of your physical; however, it may be appropriate, according to your insurance guidelines, for BMG to generate a charge for an office visit, which would include a co-pay. If time does not permit, we can schedule a separate appointment.

Following are examples of specific health concerns that may not be covered as part of your physical:

  • A sinus infection
  • Sore throat (and testing for strep)
  • New cough
  • New or changed headache pattern
  • Abdominal pain
  • Pelvic pain
  • Depression or anxiety
  • Joint pain, both specific and general
  • General fatigue
  • Sleeping problems
  • Irregular periods
  • Significant changes in status of a chronic health problem

If you have concerns about whether a charge for an additional office visit will be generated, ask your health care provider for more information.