Your insurance provider more than likely covers the cost of a yearly physical exam with your primary care physician. Getting a yearly physical is extremely beneficial – it establishes your baseline health so that if you become ill you know what your normal is. Other benefits: You may discover chronic issues before they become a serious problem, and you establish a relationship with your physician.  

However, there is a scenario that is becoming more frequent in these visits. Say your doctor exams you and you complain of feeling light-headed in the mornings. The doctor may suggest some bloodwork be done, and you walk down the hall to see the phlebotomist.

A few weeks later there is a bill in your mailbox from the doctor’s visit you thought would cost you nothing. This is referred to as a split bill. While your physical exam and yearly screening were free of charge, the extra bloodwork that was done as a consequence of your complaint was not.

How to Avoid Billing Surprises

Some doctor’s offices have added information about this to paperwork as you check in for a physical; they will ask if you have other questions or health issues to address and may inform you that there might be costs associated with that. However, not everyone is doing this. To avoid a billing surprise, you can take these steps:

  • Call your insurance provider and ask exactly what screenings and tests are included in your yearly exam.
  • If there is something else your physician suggests getting done, it may be wise to schedule a separate appointment so that there is no confusion on what was done for your yearly physical. If you prefer to save time, be prepared to pay separately.
  • You can also ask questions and seek advice but do not accept any treatment at the time of your physical.

Medical Billing is already very complicated, and most people, of course, do not know how to navigate the system. Your best bet is to become as familiar with your health plan as possible and always question services before they are done. Numbers to know:

  • Deductible – The amount you pay per year before your insurance will start to pay for things.
  • Co-insurance – The percentage you pay for a health care service after you’ve paid your deductible. For example, your co-insurance might be 20 percent. That means that you’d pay $20 for a $100 doctor’s visit (after you reach your deductible.)
  • Out-of-pocket maximum – This is the most you will pay for health care on your own; once you reach this number, insurance will cover the rest. This is critical when planning ahead for expensive procedures or care. Often it’s best to place those appointments later in the year if you can.

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