Preventive Physical vs. An Office Visit – What You Need to Know!

What’s the difference between a preventive physical and an office visit, and can I be charged for both in the same visit?

At first glance, a physical and an office visit may seem like the same thing…

BUT, there is a difference. It is important to understand the differences between the two, because it may affect your costs.

Here are the main differences:

 A Preventive Physical is:

  • A thorough review of your general health and well-being
  • Your provider will complete a physical exam and make recommendations regarding your general health that usually focus around diet, exercise or disease screenings and well-being
  • Typically, GHC covers preventive physicals at no charge. But you should refer to your Summary of Benefits or Certificate for exact benefit coverage.

 An Office Visit is:

  • An appointment to discuss specific, new or existing health problems.
  • Your provider may then prescribe medication, order additional tests like lab work or X-rays, refer you to a specialist or discuss other treatment options.
  • Depending on your benefits, an office visit usually results in additional costs to you.

Based on the definitions above, you may be wondering if the same appointment can be considered both a physical and an office visit? The answer is, yes.

On occasion, one appointment can meet the requirements for both types of visits. If this is the case, your provider will submit a charge for both a preventive physical and an office visit. If your preventive physical includes consultation or treatment

for a specific condition, your provider is legally required to document additional medical services on your bill.

So, what does this mean for you?

While combining a preventive physical and an office visit will save you time by eliminating an extra appointment, it may also affect your costs. Providers must bill your visit based on both the reason you initially scheduled the appointment and what is done during the appointment. For this reason, it’s important to remember that when you see your provider for a physical, something more than a general evaluation may result in unanticipated out of pocket costs for you based on your benefit plan.

We hope this article has helped to clarify the difference between physicals and office visits. As always, if you have further questions about your insurance coverage or costs you can review your Summary of Benefits and Coverage by clicking here. You can also call our Member Services team Monday through Friday, 8 a.m. – 5 p.m. at (608) 828-4853.