What’s included in your physical:

• Preventive care (Anticipate future illness and guide the patient to reduce risks)
• Routine screening tests
• Medical/family history
• Male/female physical exams
• WIAA pre-participation sports physicals

What is the difference between a preventive care physical exam and a problem-oriented care?

A preventive care physical exam is an opportunity for your provider to conduct an overall “checkup” on your health and well-being. Your provider may also provide suggestions to improve your health. As such, physicals play an important role in preventive care.

What you may not know

Prevea Health encourages you to communicate with your provider because it’s an essential piece of the provider-patient relationship. During your preventive care physical exam, we urge you to ask your provider any and all health-related questions.

However, if you have a problem-oriented issue and receive problem-oriented care, it is not part of the physical exam. Prevea is required to charge for these services by the Federal Center for Medicare and Medicaid Services (CMS). CMS has a very specific definition of what is included in all physicals. If you know the difference between preventive care and problem-oriented care, you can go to your preventive care physical exam confident in what is and isn’t covered as part of the physical.

When does preventive care become problem-oriented care?

Think of your preventive care physical as being similar to a dental cleaning. The cleaning – just like a physical exam – covers set services for you. If you have X-rays at the dentist’s office or need cavities filled, those services are billed separately. So, services or needs above and beyond your physical exam are billed separately as well.

Here is an example of how a preventive care physical exam can turn into problem-oriented care:

You’re seeing a provider for your annual preventive care physical and, as she’s listening to your lungs, you mention that your wrist has been hurting a lot lately. You tell her your hand is weak and hurts when you type, and you can’t help but wonder if you’re developing carpal tunnel syndrome. Asking that requires the provider to deliver problem-oriented care.

By asking that question, the physical exam changed from a preventive care situation to a problem-oriented care situation. Because of that, Prevea Health must charge separately for services outside the scope of the physical exam.

You should ask questions. However, due to the limited amount of time allotted for your physical exam, you are welcome to make a separate appointment to ensure your questions are thoroughly addressed.

Questions?

If you have specific questions about what may or may not be covered by your insurance, please contact your insurance company before your physical exam. Your insurance company may not cover all services performed outside of your physical (such as screening tests or lab work).

If you have questions about the costs associated with your care, please contact Prevea Health at (920) 496-4700 or (888) 2PREVEA. All other questions about problem-oriented or preventive care can be addressed by your local health center.