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What Is and Isn’t Considered During My Yearly Preventive Physical Exam?

This notice pertains to the components of a preventive physical examination (preventive services or wellness visit) that are normally covered by your medical health plan. Also, it includes what services are not normally covered by your medical health plan during a preventive physical examination.


Services NOT Normally Covered by Insurance Plans During a Preventive Physical Exam/Wellness Service:


  • Evaluation and Management of specific acute problems or illness. (Examples would be discussion of a recent cough, sore throat, pain, injury, or refills or lab orders for chronic medical conditions, such as high blood pressure, diabetes or asthma.)

  • Procedures other than a pap smear. (Examples would be mole removals, joint injections, and skin biopsies.)


Preventive Physical Examination Components Normally Covered by Insurance Plans Include:


  • Screenings (evaluation to detect a disease that is present, but as yet unknown to the person and physician) for common or preventable diseases (Examples would be screenings for high blood pressure, obesity, high cholesterol, diabetes, and certain forms of cancer.)

  • Complete physical examinations (Paps for women included)

  • Review of immunization history and administration of any if necessary

  • Counseling on healthy living choices, normal development and recommendations for proper diet and exercise

  • Diagnostic testing, if appropriate. (Examples would be pap smear, fasting cholesterol and blood sugar tests, colonoscopy, bone density, and prostate blood test.)


Our providers will welcome discussing and/or providing any of the services that may not be covered by your medical health plan during your physical examination. However, please keep in mind that if your medical health care plan does not allow for, or applies a copay or deductible, to this additional non-wellness service on the day of your physical, then you will be responsible for any charges related to that additional service.  Also keep in mind that in our effort to provide efficient and timely care to patients, there may not be time at a Preventive Physical to address non-wellness issues.  We may require that an additional office visit be made to handle these issues.

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