Most consumers are aware that fully insured group medical insurance plans now cover routine annual physicals with no co-pays or deductibles. But, in practice, there is more to the story!
We recently sat down with the Group Medical Benefits Professional that we work with, and she went on to explain. “After the exam, the physician usually orders a series of tests that are appropriate for the age and condition of the patient. Possibly some are outside the scope of what is considered part of the routine exam and in that instance, the test or lab work will apply to the deductible or co-pay. In addition, it is important that the various ‘appropriate’ tests be coded properly by the provider’s office, as that too, can result in items accruing to the deductible or co-pay. As we use our health insurance, it is important to understand how to have it work well for us. If a consumer wishes to have only those tests that will not result in additional out of pocket expenses, it may be appropriate to discuss this with their physician, making it clear they do not want additional tests. Even then, it is possible that the consumer may have to follow up with the lab or physician’s office if not all testing fees are waived. Coding may need to be reviewed and claims may need to be resubmitted. I am aware that a local suburban hospital lab now prints off an informational sheet prior to the lab testing, advising the patient that a certain test is outside the scope of a routine exam. In that way, the consumer can make the decision if he/she will proceed with the test.”
Understand that annual physicals assess health and help to diagnose medical conditions. Working with your physician and understanding your benefits will help you to get the most value from your insurance plan!
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Elliot Whittier Insurance Services, LLC is a local Trusted Choice® agency that represents multiple insurance companies, so it offers you a variety of personal and business coverage choices and can customize an insurance plan to meet your specialized needs. You can visit Elliot Whittier online at www.ElliotWhittier.com, email email@example.com, or call 617-846-5000 and ask for Chris Millerick.