Understanding Your 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
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
- Review of age- or gender-appropriate screenings
Problem- related visits address issues such as:
(usually only partially covered by insurance)
- High blood pressure
- 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 clinic billing questions, call:
608-847-9771 or 9772