Preventative vs Problem Visits

What is and what is not covered during a preventive visit­—often referred to as a wellness visit for preventive healthcare services are common questions.

We follow standard healthcare billing practices and insurance rules for the type of care you receive. From a visit standpoint there are three different options.

As soon as a health problem is discussed in your annual exam or other preventive care visit—whether it’s a chronic illness or injury or something that just came up—the healthcare becomes problem-focused. When that switch occurs, you can be billed for anything related to the problem-focused part of your visit. Copayments and deductible amounts apply.

Preventive/Wellness Visit

Preventive/wellness visit includes:

  • Conducting an exam based on your age and gender.

  • Height, weight, blood pressure, and other routine measurements will be taken.

  • A review of your medical and family history

  • Providing advice about staying healthy and healthy living choices.

  • Identifying risk factors.

  • Personalized health advice

  • Screening tests based on age, gender or lifestyle.

  • Review of your current providers and prescriptions

  • Keeping your immunizations up to date based on your age and gender.

Annual preventive/wellness visits are covered by many health insurance plans POTENTIALLY with no out-of-pocket costs to you.

Problem Visit

Problem Visit

Standard office visit for a problem includes:

  • Discussion of any new health problem, illness or injury.

  • Management of chronic, ongoing health problems and/or medications.

Health insurance treats each of these visits as a single office visit with varying coverage. Your insurance provider may pass some or all of the cost on to you.

Combine Your Visits

When time allows, you may decide to combine your preventive/wellness visit with a problem visit. If you’re here for a preventive/wellness visit and you’d like to discuss concerns not covered under preventive services, you have the option to do so. Please be aware that separate charges WILL apply.


Likewise, if you are here to discuss a problem, your provider could offer preventive/wellness visit services to help you avoid having to schedule an additional appointment to receive those services.


Federal law requires us to bill services for preventive care and problem visits separately.

Billing & Insurance Standards

Call your insurance representative before your appointment and ask specific questions:

  • Is a preventive/wellness visit covered under my policy?

  • What screenings are covered (ie: labs, imaging)?

  • What vaccines are covered?

We will submit your bill to your insurance. It is likely that you will have some out-of-pocket expense. 

For more information or to schedule an appointment give us a call at: (605) 348-4141