Bayside Family Practice, LLC
Easton's first Direct Primary Care!!

Billing services and physicals

Insurance companies have very specific regulations about billing for health care services.  As your healthcare provider we are required to follow those regulations in how we report to the insurance company in a universal code system that is linked to the service, treatment, or procedure that was provided.


Physical exams, or wellness visits, are screening exams to make sure the you don't have any unknown medical issues.  They are sort of like an a car inspection-no known problems but inspecting to make sure nothing is wrong.  They are very involved and time consuming.  It is not the time to address new problems or review old ongoing problems.  As such, you may need to return to address other issues.

 

Occasionally an issue will arise that cannot wait for another appointment.  It is not uncommon for patients in the course of one visit to receive care in both the form of a regular check-up and evaluation of an acute or chronic illness.  For example, a person being seen for a routine annual exam may also present with a chest pain.  The person is evaluated and treated for the other problem(s) as well as examined for their annual exam.  Both services must be reported to the insurance company.  Another example is a person with uncontrolled hypertension and diabetes may have this evaluated at the same time as the annual exam.  Again, both services must be reported to the insurance company.

 

Insurance companies handle these reported codes differently.  Some insurance companies may require an additional co-pay or charge; this is determined entirely by your insurance company.  If you have questions, please check with your specific insurance company.

MEDICARE

 

Medicare does not currently cover annual exams in the traditional sense.  There is a Welcome to Medicare Physical and an Annual Medical Wellness Assessment.   We can perform either exam in the office.  Please remember that these exams do NOT include medication refills or addressing problems.


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