Billing Frequently Asked Questions

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 diagnostic 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 diagnostic 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.

Why was my Urgent Care visit billed as an Emergency Department visit?

Your visit was billed as Urgent Care; however, some insurance plans process hospital-based Urgent Care visits under the Emergency Department benefit. When this happens, your out-of-pocket costs may differ from what you expected based on your plan’s deductible, copay, or coinsurance. While we bill according to the services provided, your insurance company determines how your benefits are applied. If you have questions, we encourage you to reach out to your insurance company. We are also happy to review how your visit was billed and provide information to support your conversation with your insurer.

Why did I get billed for a diagnostic colonoscopy?

We understand that many patients expect a screening colonoscopy to be fully covered by insurance. Your procedure was scheduled and benefits determined by what was scheduled. However, once the provider is performing the procedure, they determine what is the best clinical course of action for the patient. However, if a polyp is removed or a biopsy is performed, some insurance plans may reclassify the procedure as diagnostic, which can change your out-of-pocket costs and apply deductible, copay, or coinsurance amounts. We bill based on the services performed and medical documentation, while your insurance company determines how the procedure is categorized under your specific plan. If you have questions, we encourage you to contact your insurer, and we’re happy to review your billing details to support that conversation.