NCH is part of Endeavor Health

Learn more

Endeavor Health Medical Group

Annual Wellness FAQs

Know Your Insurance to Avoid Billing Surprises

Recent updates to many health insurance plans have changed the way some key services are provided and billed, including physician office visits often referred to by the following names:

  • Annual Checkup
  • Preventive Care Visit
  • Annual Physical
  • Annual Health Assessment (AHA)
  • Annual Wellness Visit

What has changed?

Known by many different names, an annual wellness/preventive visit does not always include the “hands-on” physical exam you may have received in the past. If your chronic conditions or new problems are being addressed with your physician, an additional office visit may be charged and could result in a copay or a charge applied to your deductible.

Is Medicare the only insurance that does not cover a “hands-on” physical as part of their wellness/preventive plan?

No, there are other insurance plans that follow these same guidelines. Medicare is only one example. A Medicare wellness/preventive exam does not cover the discussion, diagnosis or treatment of a disease during your Medicare wellness visit.

What is included with a Medicare Wellness exam?

A Medicare wellness exam includes a questionnaire, the creation of a personalized prevention plan for each patient as well as a screening for depression, safety risks and cognitive impairment. The Medicare wellness visit also includes counseling for a healthy lifestyle and establishing a schedule for Medicare’s screening and preventive services.

How can I be proactive to avoid any unforeseen charges?

Prior to coming into the office for your scheduled wellness visit, we encourage you to contact your insurance to understand what is covered under your specific plan.

What are the questions I should ask my insurance provider?

  • What labs or testing are covered under my wellness/preventive plan visit?
  • Does my wellness visit include a “hands-on” physical to discuss my chronic conditions or any new problems?

In addition, please note that if your NCH provider is monitoring a diagnosis or medication levels, testing will be ordered with the appropriate diagnosis code. Charges associated with a diagnostic code may count toward your deductible. Screening codes are only used when there are no symptoms or diagnosed condition. We are unable to change the code after the visit or lab draw.

Endeavor Health Medical Group accepts a variety of insurance plans. To check the details of your coverage, contact your insurance company.