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Understanding Medical Bill

Preventative vs. Problem-Related Care

An important part of actively maintaining your health is scheduling regular preventive care appointments. These visits help to identify potential health problems in their early stages, when they may be easier and less costly to treat.

Commercial insurance carriers often provide full or partial benefits for preventative care exams. They do not, however, typically cover the total cost of problem-related visits (ones in which you address health issues that need to be treated or reviewed). It is important to know the difference between these types of appointments so that when you receive a billing statement for some, or all, of your visit, you will be able to understand the charges.

Below is a list that may help you better understand how appointments are categorized, and what types of services may or may not be covered by your commercial insurance plan. Please note that this is a general list. The best way for you to know the specific benefits of your plan, is to contact your insurance provider directly.

Preventative care appointments may include:
(often covered fully by insurance)

  • Review of past medical, social and family health history
  • Physical exam and review of body systems
  • Assessment of risk factors for future health concerns
  • Immunizations
  • Review of age- or gender-appropriate screenings

Problem- related visits address issues such as:
(usually only partially covered by insurance)

  • High blood pressure
  • Diabetes
  • Joint pain
  • Adjustment or renewal of medications
  • Cholesterol issues

Things to Consider

  • Review your summary of benefits prior to your appointment to see what your insurance company will cover.
  • When scheduling a preventative care appointment, use the terms "routine preventive exam" or "screening physical" instead of using the term "check-up."
  • When you talk with your provider, let him/her know that you are there for a routine preventive exam.
  • If new or existing health issues are evaluated and/or treated during your preventive visit, you may incur additional charges.

Please note that Medicare coverage is different from commercial insurance coverage. Medicare does not cover preventative visits, although some Medicare Advantage plans do. Contact your carrier for specific details.

If you have any concerns regarding an upcoming appointment, or questions about a bill, please call the appropriate number from the list provided.

Thank you for choosing Mile Bluff to care for you!

For billing questions, call 608-847-6161.

Price Transparency

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