Billing Frequently Asked Questions
Preventative Exams, Medicare & Insurance Coverage
What is a preventative health exam, and is it covered by my insurance?
- A preventative health exam, often called an annual physical, is a yearly check-up where your primary care provider:
- Asks you questions about your overall health;
- Provides advice on how to prevent potential health issues;
- Manages minor health problems;
- Conducts a physical exam.
- Medicare Part B offers a different type of annual visit called the Medicare Annual Wellness Visit. During this visit, your provider will:
- Perform or review a health risk assessment.
- Review past medical history and family history.
- Screen for cognitive impairment and depression risk.
- Review functional ability and safety level.
- Your preventative health exam or Medicare Annual Wellness Visit can turn into a sick visit if your provider needs to address a new medical issue or assess and manage chronic condition(s) during your annual visit. This part of the visit is billed separately and may result in additional charges.
- Most insurance companies cover sick visit evaluations, tests, and treatments; however, you may need to pay a co-payment, deductible, or co-insurance for the sick visit, even if it occurs during your preventative health exam or “Annual Medicare Wellness Visit.”
Why didn’t my insurance cover all of my lab testing? Health test? Immunizations?
- Medicare and many commercial health plans cover certain screening tests (such as cancer and cardiovascular disease screenings). Coverage depends on many factors, such as age and your specific health insurance plan.
- If you have an existing condition or need testing to monitor a condition, your test will be billed differently and may not be considered screening.
- Some tests and immunizations might not be fully covered, and you may have to pay a deductible or co-insurance.
- Calling your insurance company is strongly encouraged. They can explain your coverage and benefits.
I believe I received a bill in error. What should I do?
- Call Patient Financial Services at (603) 228-7145 immediately to determine if your bill is due to:
- Insurance coverage, eligibility, or authorizations;
- Coding-related, including CPT, ICD, or modifiers;
- Patient responsibility, including deductibles, co-pays, or co-insurance.
