People often have questions about the difference between an annual wellness visit and a “regular office visit”. Sometimes patients can get frustrated because all of their concerns are not addressed in their annual visit, but there are reasons for this, and that can be dependent on the reason for the visit, the time allotted, and how insurance billing works. Both types of visits are important for overall health, but they serve different purposes and are conducted in different ways.
In general, an annual wellness visit is designed to focus on preventive health and maintaining well-being, while a problem-focused visit, also known as an evaluation and management visit (E&M), is focused on diagnosing and managing specific health issues.
An annual wellness visit is a once a year visit that is focused on preventative care and to maintain and make improvements on your overall health. The doctor’s job during these visits is to focus on identifying your health risks according to your age and family history. It is also the time to promote a healthy lifestyle and discuss nutrition and movement habits. We will review your personal and family history, your medications, and update your health provider team. We will make sure appropriate screening exams and orders are in place and discuss a personalized prevention and health maintenance plan. Annual visits are for both established and new patients. It is important to note that there will not be treatment and management of specific health concerns at this visit, though you may want to. We will encourage you to make a separate appointment so that we can do so. It is not because it is not important to us, but this is how insurance billing works. Your insurance allows one wellness visit a year where there is no out-of-pocket cost for you, nor is it applied to your deductible.
What happens if you have a specific concern (or four!) that you want to discuss? This is evaluation and management. In our office, upon scheduling, these are known as a follow up visit for established patients, or a new patient appointment if you have not been seen here before (or it has been longer than 3 years). During these visits we will evaluate the current set of problems you wish to discuss via a detailed interview, do a physical exam when appropriate, order lab tests or imaging, write appropriate referrals, and design a personalized treatment plan. These visits are also for reviewing labs, medications, and treatment plans from other visits, and addressing ongoing health problems. Unlike the annual visit, these visits do apply to your deductible and will have a copay or coinsurance, as indicated by your health insurance plan. In our office, these visits are 30 minutes long if you are an established patient, and an hour long if you are a new patient. Because we treat holistically, we will try to address all of your concerns, however there are time limitations and you may have to schedule multiple visits, depending on your needs. Insurance billing is based on both time and complexity of the visit.
We hope this helps! Insurance benefit plans are all different, so be sure that you’re familiar with yours so there are no surprises with your billing! If you do not have insurance, or we do not take your plan, then you can pay cash for your appointment, and there are different rates depending on the type of the insurance or the length of the appointment. You can always call the office for more information.