Telling the difference between a preventive visit and an
office visit can be confusing, especially if you wind up having both kind of
services in one visit.

Preventive Visit

The purpose of a preventive visit is to review your
overall health, identify risks and find out how to stay healthy. The cost of
preventive visits may be covered by your plan at no cost to you. During your
preventive care visit, your doctor may review your health risks and talk with
you about:

  • Your current health
  • Your family health history
  • Past illnesses and surgeries
  • Risks you may have for specific conditions
  • How to maintain a healthy lifestyle

Medical Visit

The purpose of an office visit is to discuss or get treated
for a specific health concern or condition. Depending on your health plan, you
may pay for these services received during an office visit:

  • Discussing or getting treatment for a specific
    health concern, condition or injury
  • Lab work, X-rays or additional tests related to
    a specific health concern, condition or injury

The doctor determines if the services you receive are
billed as preventive or medical. Claims are paid based on what the doctor’s
office submits to your health plan.

If your doctor discusses a health problem during your preventive office visit, he or she may bill part of the visit as preventive and part as a medical office visit. Depending on your specific health plan, preventive services may be covered without a copay or deductible. For medical services, copays and deductibles may apply.

If you want to know about costs, ask your doctor for an estimate of fees before your scheduled appointment visit.