The comprehensive wellness exam at Altitude Family and Internal Medicine’s goes well beyond the standard yearly physical.  We have designed this service to be a comprehensive evaluation of your current health status and unique risk factors and threats focusing on prevention, early diagnosis and treatment, and lifestyle enhancement to proactively optimize your health.

The comprehensive wellness exam is one of the most thorough assessments available, rivaling executive physicals often costing several thousands of dollars in regional and national health facilities.  Several hours of preparation go into each individual wellness visit to ensure a thorough and efficient service especially for you.

We recommend this service annually.

A laboratory evaluation will be performed a few weeks prior to your wellness exam.  On the day of your exam you can expect to spend about 40 to 60 minutes in our office for additional screening evaluations, individualized diagnostic testing, a complete physical exam, analysis and review of your results, update on chronic health issues, post-visit planning, and coordination of recommended follow-up services.  You will be provided with an individualized color-coded assessment and plan to help guide you after the visit.

Many people are surprised to find out that the Affordable Care Act does not actually require insurance companies to provide a free preventive physical exam.

As of January 1, 2015, most insurance plans are required to cover at least 15 specific preventive services with no out-of-pocket cost.  The covered services frequently make up a portion of the comprehensive wellness exam.

The Affordable care act does require that an Annual Wellness Visit (not including a phsyical exam) be covered for Medicare beneficiaries.  While we have found that most commercial insurance policies do provide some level of coverage for yearly physicals, the Federal mandate does not specifically require individual or group plans to cover this service.

Most components of the comprehensive wellness exam are covered by insurance benefits.  However some components may be subject to coinsurance or deductibles.  This varies considerably by insurance company and policy.

Insurance companies are only required by law to cover the mandated preventive services with no out-of-pocket costs listed at the above link.  Other components of the comprehensive wellness exam including the actual services required to facilitate covered preventive care, the ordering and interpretation of labs and tests, and even the examination may be subject to cost sharing strictly based on your specific plan benefits.

The primary preventive services discussed in the Affordable Care Act include:

1. Abdominal Aortic Aneurysm screening
2. Alcohol Misuse screening and counseling
3. Aspirin use
4. Blood Pressure screening
5. Cholesterol screening
6. Colorectal Cancer screening
7. Depression screening
8. Diabetes screening
9. Diet counseling
10. HIV screening
11. Certain Immunizations
12. Obesity screening and counseling
13. Sexually Transmitted Infection prevention counseling
14. Syphilis screening
15. Tobacco use screening and counseling

Even though many patients will have some financial responsibility for the comprehensive wellness exam, in most cases the amounts are relatively small while the benefits of the service can be considerable.  It is impossible to accurately calculate an individual patient’s financial responsibility until the claim is billed to and processed the insurance company.  While we cannot guarantee the actual out-of-pocket costs in your specific case, we can provide general guidelines based on recent claim data.

Most patients with government sponsored insurance, especially for those with Medicare and a secondary insurance, will have minimal or no financial responsibility for this service.  Typically, patients with private insurance will owe a copay and sometimes coinsurance on a small portion of the visit.  Those patients who have not met their deductible, on average will owe a bit more than their counterparts who have met their deductible.

The Federal government is considering requiring insurance companies to provide a tool to estimate of your personal financial responsibility prior to a service being provided.  Unfortunately, these systems are not widely available and have been considerably inaccurate and ineffective in the past.

The out-of-pocket costs for the comprehensive wellness exam generally tend to be quite reasonable.  Our general policy is not to modify this service as this would undermine our ethics, integrity, and ultimately the high quality of care that we deliver, which is most likely why you have chosen Altitude as your healthcare provider in the first place.  If you are suffering a financial hardship, it is advisable to discuss this with your provider prior to the delivery of any service.

While we do endeavor to be conscientious regarding healthcare costs, coding and billing for your office visits are regulated by Federal law.  We strictly adhere to the established guidelines, and have no flexibility to deviate from these guidelines.

Our providers will generally require you to be seen to establish care prior to scheduling the wellness visit.  We see your Annual Preventive Exam as one of the most important services that we have to offer.  Without having a chance to meet you, hear a little bit about your medical history, and learn about your health goals, we cannot consider how to best deliver this service for you.

The good news that you only have to be seen once in our office to establish care.  At that visit we can order and collect blood for your laboratory evaluation, plan on any other testing necessary, and schedule your Comprehensive Wellness Exam.

While this one-time visit to establish care may be subject to a copay, coinsurance, or deductibles, it should both save you time and maximize the value of this service.

No, there is no deductible or copay for either service. But keep in mind that either of these visits could cost you some money out of pocket. For example, you may require additional testing or need to have a medical condition evaluated or treated in a way that goes beyond the definition of a wellness visit. Under Medicare rules, a portion of the treatment may not be considered preventive, and may be applied to your secondary insurance, your 20% coinsurance, or your deductible.

Maybe.

Your insurance company exclusively determines which preventive tests are covered, when they should take place, and whether a copay, coinsurance, or deductible is required for these.

Regarding lab work, the Affordable Care Act only requires coverage for two screening blood tests, basic cholesterol and diabetes screening, and does not define how often these should be performed.  In our professional opinion this a far too limited.

Regarding screening tests in general, a screening test is given to those who have no symptoms of a condition, such as measuring cholesterol levels in people who have no symptoms of cardiovascular disease. A diagnostic test is used to confirm a suspected condition once initial testing has revealed its possibility.  Sometimes a screening test becomes diagnostic if potential abnormalities are found and more testing must be performed.

As an example, the screening cholesterol test can be considered diagnostic if you have a history of high cholesterol or a related condition, or if that test finds an abnormality.

As another example, a screening colonoscopy may be considered diagnostic if it reveals a polyp or other abnormality.

Depending on what services are performed you may see several different codes on your Explanation of Benefits.  Below is a list of common CPT codes.  Most claims will only have a few of these codes.  This list is not fully inclusive and may change periodically.

• 81002 – Urinalysis
• 82274 – Fecal Immunochemical Test
• 93000 – Electrocardiogram
• 94060 – Pulmonary Function Testing
• 9921x – Office Visit or Evaluation
• 9939x – Complete Physical Exam
• 99406/7 – Tobacco Cessation Counseling
• 99420 – Health Risk Assessment and Depression Screening
• G0101 – Pelvic and Breast Exam (Medicare)
• G0102 – Digital Rectal Exam (Medicare)
• G0401 – Welcome to Medicare Visit (Medicare)
• G0402 – Electrocardiogram (Medicare)
• G0438 – Annual Wellness Visit, Initial (Medicare)
• G0439 – Annual Wellness Visit, Subsequent (Medicare)
• G0442 – Alcohol Misuse Screening (Medicare)
• G0444 – Health Risk Assessment and Depression Screening (Medicare)
• Q0091 – Pap Smear (Medicare)

Here are a few resources:

• Your Guide to Medicare’s Preventive Services
• Patient Protection and Affordable Care Act (HR 3950)