Not all appointments are the same. While the quality of care you receive doesn’t change with the kind of visit, insurance coverage often can. It is important to know the difference between visit types —and how that can change—when you’re going to the doctor. This helps lessen stress during your appointment and make any clinical charges easier to understand.
There are two major types of visits: preventive and problem-focused visits.
A preventive visit is typically done to review your overall health, identify potential risks, and to learn ways to stay healthy. These annual appointments, also referred to as wellness visits, are covered by many insurance plans.
Preventive visits can vary with Medicare coverage. Original Medicare plans cover an Annual Wellness Visit but not an annual, hands-on physical. Medicare Advantage plans cover an Annual Wellness Visit and often a hands-on physical.
If you have a preventive care visit issue where your chronic illness or new issue is discussed, this may change your visit to a problem-focused office visit.
New Problem or Office Visit
The purpose is to discuss and/or receive treatment for a new problem or chronic established problem. The biggest difference between preventive visits and office visits is insurance coverage. Office visits are when you discuss or get treated for a specific health concern or condition. Patients may have to pay for the visit as part of a deductible, co-pay, or other method.
If you go to the doctor to seek treatment for a specific issue, your appointment is going to be an office visit. In addition, any lab work, tests, or x-rays would be considered an office visit.
Other kinds of visits
While preventive visits and office visits are the most common, there are other kinds of visits.
Often screening services will be covered by insurance. However, when the goal of the appointment is diagnostic, or concerned with the diagnosis of an illness or injury, this may change coverage. For instance, there are two kinds of mammography exams: screening and diagnostic. A screening mammogram can detect breast cancer at its earliest possible stage. A screening is used for patients without any signs or symptoms. On the other hand, a diagnostic mammogram is a problem-solving exam performed and consulted by a team that is determining what is best for your unique situation.
What happens when you have both on the same day?
Sometimes it’s easier for you to schedule a preventive and office visit on the same day. Even though you are visiting the office once, it will be billed as two different visits. While this does save time, it’s always important to check with your insurance if you have questions about your coverage.