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What does a routine checkup or screening cover?

By The Health News Team | April 13, 2017
What does a routine checkup or screening cover?

Maintaining and improving your health with regular preventive care, including routine checkups and screenings, can help you stay healthy, and allow you and your doctor to work together to help you reach your personal health and wellness goals.

Even if you’re feeling fine, scheduling preventive care visits is important for early detection, and can help you avoid serious health problems down the road.

“Preventive care allows you to identify symptoms before you know they are issues, and can minimize effects in something that is found,” says Dr. Cary B. Shames, DO, chief medical officer of Sharp Health Plan.

During your preventive care appointment, your doctor will determine what tests or health screenings are right for you based on your age, gender, health status and family history. Here’s what’s typically covered:

  • Well baby, well child and well adult physical exams
    Included: A routine exam. You can discuss your medical history and medications you take. Your doctor may also conduct routine screenings at this visit.
    Not included: Any discussion of new medical concerns and follow-up visits based on the results of your well exam.

  • Immunizations
    Included: Flu and tetanus shot, MMR vaccination, and Hepatitis A and B vaccinations.
    Not included: Majority of travel vaccines.

  • Screenings
    Included: Breast cancer, cholesterol, cervical cancer, colorectal cancer, depression, diabetes, hypertension, obesity, prostate cancer, sexually transmitted infections, tobacco and alcohol use.
    Not included: Follow-up visits based on the results of these screenings.

Unlike seeing the doctor when you’re ill, which requires a copayment or deductible, preventive care visits are available at no additional charge and focus on evaluating your health when you are symptom-free.

Before you schedule an appointment, understanding the parameters of preventive care is important. If you discuss new medical concerns or a current illness, the visit may be considered a medical treatment by your doctor, which could require a copayment or deductible.

Here are some tips to help you stay within the guidelines of what’s considered preventive care:

  • You should avoid discussing new medical concerns at a preventive care visit. Even short remarks about an increase in headaches or knee pain could result in charges. You may prefer to schedule a separate regular office visit to address these issues.

  • Make sure you schedule your preventive care appointment with an in-network provider. If not, you run the risk of paying high out-of-pocket costs for a doctor out of your network. Visit your health insurance plan’s website or call the number on your insurance card if you are uncertain about the network status of your doctor.

  • When you make an appointment, it is helpful to tell the customer service agent that this is a “preventive care visit.” This way when you arrive, the office staff will know not to ask for a copay or deductible upfront.

Preventive care is one of the most proactive, holistic approaches you can take for your health. “It allows not just for early detection of conditions that may be unnoticeable by patients themselves, it can also improve patients’ well-being and quality of life,” says Dr. Shames.

Sharp Health Plan offers additional resources on preventive care. Learn more.

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