WHY DID I GET A BILL FOR MY ANNUAL GYN EXAM?
Learn the difference between a preventive visit and an office visit, including when you’ll have to pay for the visit.
An annual exam or “pap smear visit” is scheduled and coded as a preventative visit and is covered by most insurance plans at 100% with no out of pocket cost to the patient. However, additional services or discussion at a preventative visit can result in additional charges.
A Well Woman Annual Visit: Routine gynecological visits are recommended every year starting in your teens. The purpose of the visit is to maintain health, screen for disease, check for abnormal symptoms, and education on how to remain healthy.
What is not covered: Any symptoms or problems you are having? Specific discussion on a particular concern or questions regarding what you should do about a certain result or discussing a switch in medications.
WHEN DOES A PREVENTATIVE VISIT BECOME AN OFFICE VISIT?
A preventive care visit is different from an office visit:
The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan covers 100% of a preventive visit when you see a doctor in your plan network.* (You are encouraged to call your plan and confirm that we are in Network prior to your visit.)
The purpose of an office visit is to discuss or get treated for a specific health concern or condition. You may have to pay for the visit as part of your deductible, copay and/or coinsurance.
If during your scheduled preventative visit, you discuss concerns or are counseled and /or treated for findings that are not routine, those will be coded accordingly and a bill for an additional appointment may be generated. See Example below.
1. Patient comes in for a routine annual without any complaints. She mentions to the doctor that her last cycle was irregular and she is unsure if it’s a problem. The doctor then spends time discussing the irregularity and determines labs and an ultrasound are needed to investigate further.
2. Patient comes in for a routine annual visit without concerns. During the visit, the doctor asks routine screening questions (example- do you have frequent urination? Do you have breast pain?). The patient responds yes to one or more of these questions and the doctor appropriately begins to address each concern by taking a more detailed history of the concern and counseling the patient on why this is not a problem (discussion of caffeine intake or hormonal related cyclical breast tenderness). Alternatively, the additional history may reveal a need to order test to determine if this is an issue (example- urinalysis, breast ultrasound).
These examples demonstrate when the visit becomes more than a routine preventative visit and requires more time, medical decision making, and notes with appropriate codes (irregular menstrual cycle, urinary frequency, breast tenderness etc.) to be added to the records and may result in costs to the patient dependent on their insurance plan.
IF I AM ALREADY THERE FOR MY ANNUAL VISIT, WHY AM I BEING CHARGED FOR A SEPARATE VISIT? ISN'T THAT THE OFFICE 'DOUBLE DIPPING'?
Please understand that we dedicate time to make sure you are healthy and are taking the steps towards wellness during each visit. The extra time spent on addressing specific conditions is billable. Your insurance company will determine whether you have a copay or partial responsibility for that service.
We encourage patient’s not to wait until their preventative visit to discuss problems but we understand and accommodate whenever we can.
Remember your doctor is being reimbursed for their time, their knowledge, and expertise, as well as the time and services provided by the office staff.
If you have any questions regarding a bill from our office, please contact our billing department. You can also send us a copy of the bill, along with a message through the patient portal.